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Aldo Bonaventura Department of Internal Medicine, Division of Cardiology, Division of Laboratory Medicine, First Clinic of Internal Medicine, University of Genoa School of Medicine, IRCCS Azienda Ospedaliera Universitaria San Martino – IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy

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Fabrizio Montecucco Department of Internal Medicine, Division of Cardiology, Division of Laboratory Medicine, First Clinic of Internal Medicine, University of Genoa School of Medicine, IRCCS Azienda Ospedaliera Universitaria San Martino – IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
Department of Internal Medicine, Division of Cardiology, Division of Laboratory Medicine, First Clinic of Internal Medicine, University of Genoa School of Medicine, IRCCS Azienda Ospedaliera Universitaria San Martino – IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
Department of Internal Medicine, Division of Cardiology, Division of Laboratory Medicine, First Clinic of Internal Medicine, University of Genoa School of Medicine, IRCCS Azienda Ospedaliera Universitaria San Martino – IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy

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Franco Dallegri Department of Internal Medicine, Division of Cardiology, Division of Laboratory Medicine, First Clinic of Internal Medicine, University of Genoa School of Medicine, IRCCS Azienda Ospedaliera Universitaria San Martino – IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy

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Introduction In diabetes mellitus (DM), hypoglycemia is the most feared adverse effect of glucose-lowering drugs (GLDs) such as insulin and secretagogues (sulphonylureas (SUs) and glinides). Iatrogenic hypoglycemia (IH) involves reduced motivation

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Louise Færch Department of Cardiology, Department of Growth and Reproduction, Faculty of Health Sciences, Nephrology and Endocrinology H, Hillerød University Hospital, Dyrehavevej 29, DK-3400 Hillerød, Denmark

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Anders Juul Department of Cardiology, Department of Growth and Reproduction, Faculty of Health Sciences, Nephrology and Endocrinology H, Hillerød University Hospital, Dyrehavevej 29, DK-3400 Hillerød, Denmark
Department of Cardiology, Department of Growth and Reproduction, Faculty of Health Sciences, Nephrology and Endocrinology H, Hillerød University Hospital, Dyrehavevej 29, DK-3400 Hillerød, Denmark

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Ulrik Pedersen-Bjergaard Department of Cardiology, Department of Growth and Reproduction, Faculty of Health Sciences, Nephrology and Endocrinology H, Hillerød University Hospital, Dyrehavevej 29, DK-3400 Hillerød, Denmark

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Birger Thorsteinsson Department of Cardiology, Department of Growth and Reproduction, Faculty of Health Sciences, Nephrology and Endocrinology H, Hillerød University Hospital, Dyrehavevej 29, DK-3400 Hillerød, Denmark
Department of Cardiology, Department of Growth and Reproduction, Faculty of Health Sciences, Nephrology and Endocrinology H, Hillerød University Hospital, Dyrehavevej 29, DK-3400 Hillerød, Denmark

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Introduction GH is part of the second-line counter-regulatory response to hypoglycemia and acts by promoting gluconeogenesis. In long-standing type 1 diabetes with counter-regulatory failure in terms of diminished glucagon and adrenaline responses

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R Solomon-Zemler Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

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L Basel-Vanagaite Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Raphael Recanati Genetic Institute, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel
Felsenstein Medical Research Center, Petach Tikva, Israel
Pediatric Genetics, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel

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D Steier Day Hospitalization Department, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel

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S Yakar David B. Kriser Dental Center, Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, New York, New York, USA

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E Mel Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel

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M Phillip Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel

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L Bazak Raphael Recanati Genetic Institute, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel

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D Bercovich Tel-Hai College, Tel-Hai, Israel

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H Werner Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Shalom and VardaYoran Institute for Human Genome Research, Tel Aviv University, Tel Aviv, Israel

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L de Vries Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel

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and methods Index case and family members The index case was referred for endocrine evaluation at the age of 7 months due to episodes of hypoglycemia. Blood samples were obtained from the patient’s father, mother, maternal aunt and maternal

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Hoda Gad Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar

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Einas Elgassim Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar

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Ibrahim Mohammed Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
Department of Internal Medicine, Albany Medical Center Hospital, Albany, New York, USA

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Ahmad Yaser Alhaddad Department of Mechanical and Industrial Engineering, Qatar University, Doha, Qatar

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Hussein Ahmed Hussein Zaky Aly KINDI Center for computing research, Qatar University, Doha, Qatar

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John-John Cabibihan Department of Mechanical and Industrial Engineering, Qatar University, Doha, Qatar

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Abdulaziz Al-Ali KINDI Center for computing research, Qatar University, Doha, Qatar

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Kishor Kumar Sadasivuni Center for Advanced Materials, Qatar University, Doha, Qatar

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Aliyaa Haji Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar

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Neila Lamine Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar

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Adnan Khan Faculty of Healthy Sciences, Khyber Medical University, Peshawar, Pakistan

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Ioannis N Petropoulos Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar

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Georgios Ponirakis Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar

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Alise Kalteniece Institute of Cardiovascular Medicine, University of Manchester, Manchester, UK

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Maryam Ferdousi Institute of Cardiovascular Medicine, University of Manchester, Manchester, UK

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Shazli Azmi Institute of Cardiovascular Medicine, University of Manchester, Manchester, UK

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Uazman Alam Diabetes and Neuropathy Research, Department of Eye and Vision Sciences and Pain Research Institute, Institute of Ageing and Chronic Disease, University of Liverpool and Aintree University Hospital NHS Foundation Trust, Liverpool, UK
Department of Diabetes and Endocrinology, Royal Liverpool and Broadgreen University NHS Hospital Trust, Liverpool, UK
Division of Endocrinology, Diabetes and Gastroenterology, University of Manchester, Manchester, UK

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Wajeeha Abuhelaiqa Hamad Medical Corporation, National Diabetes Center, Doha, Qatar

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Amin Jayyousi Hamad Medical Corporation, National Diabetes Center, Doha, Qatar

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Dabia AlMohanadi Hamad Medical Corporation, National Diabetes Center, Doha, Qatar

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Khaled Baagar Hamad Medical Corporation, National Diabetes Center, Doha, Qatar

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Rayaz A Malik Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
Institute of Cardiovascular Medicine, University of Manchester, Manchester, UK

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cardiac autonomic neuropathy (CAN) ( 9 ). Severe iatrogenic hypoglycemia can lead to neurological sequelae, including cerebral dysfunction, seizures and death, and recurrent hypoglycemia is associated with hypoglycemia-associated autonomic failure

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Jelena Stankovic Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark

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Kurt Kristensen Steno Diabetes Center Aarhus (SDCA), Aarhus University Hospital, Aarhus, Denmark
Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark

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Niels Birkebæk Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark

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Jens Otto Lunde Jørgensen Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark

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Esben Søndergaard Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
Steno Diabetes Center Aarhus (SDCA), Aarhus University Hospital, Aarhus, Denmark

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release and thereby disinhibit GH release ( 11 ), but the mechanisms whereby arginine stimulates copeptin and AVP secretion remain unclear. Hypoglycemia also stimulates GH and copeptin secretion, and the insulin tolerance test (ITT) is used in the

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Zhou-Qing Kang Department of Nursing, Jin Qiu Hospital of Liaoning Province, Geriatric Hospital of Liaoning Province, Shenyang, Liaoning Province, China

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Jia-Ling Huo Department of Respiratory Medicine, Jin Qiu Hospital of Liaoning Province, Geriatric Hospital of Liaoning Province, Shenyang, Liaoning Province, China

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Xiao-Jie Zhai Department of Nursing, Jin Qiu Hospital of Liaoning Province, Geriatric Hospital of Liaoning Province, Shenyang, Liaoning Province, China

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aggressive glycemic control may greatly increase the risk of hypoglycemia ( 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ). To date, seven previous meta-analyses have explored the associations between TGC/IIT and

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Yongli Fu Department of Endocrinology, The Second Affiliated Hospital of Qiqihar Medical College, Qiqihar, Heilongjiang Province, People’s Republic of China

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Yaowu Sun Higher Education Research and Teaching Quality Assessment Center, Qiqihar Medical College, Qiqihar, Heilongjiang Province, People’s Republic of China

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Jiankun Zhang Department of Clinical Laboratory, The Second Affiliated Hospital of Qiqihar Medical College, Qiqihar, Heilongjiang Province, People’s Republic of China

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Yu Cheng Department of Nutrition and Food Hygiene, School of Public Health, Qiqihar Medical College, Qiqihar, Heilongjiang Province, People’s Republic of China

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this topic. Numerous studies have reported that dysglycemia including hyperglycemia, hypoglycemia or serum blood fluctuation is an independent risk factor of mortality for critically ill patients, especially for those with diabetes mellitus ( 1 , 2

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Jared G Friedman Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States

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Kasey Coyne Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States

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Grazia Aleppo Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States

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Emily D Szmuilowicz Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States

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of average glycemia over months and as such does not provide actionable information regarding glucose patterns over the day, glucose variability, or the amount of time spent in the hyperglycemia, hypoglycemia, and target ranges or hypoglycemia ( 6

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David Q Pham Western University of Health Sciences, College of Pharmacy, Pomona, California, USA
Mary & Dick Allen Diabetes Center at Hoag Hospital, Newport Beach, California, USA

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Ashley Thorsell Sansum Diabetes Research Institute, Santa Barbara, California, USA

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Kristin Castorino Sansum Diabetes Research Institute, Santa Barbara, California, USA

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Brandon Cobb Sansum Diabetes Research Institute, Santa Barbara, California, USA

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hypoglycemia and hyperglycemia with alerts and alarms ( 3 , 4 ). Given the great advances in maternal care, most women can now expect to have a healthy and uncomplicated pregnancy, and deliver a healthy baby at the end of nine months ( 1 ). However, pregnancy

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Zi-Di Xu Department of Pediatric Endocrinology, Genetic and Metabolism, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China

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Wei Zhang Department of Children Health Care, Xiamen Maternal and Child Health Hospital, Xiamen, China

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Min Liu Department of Pediatric Endocrinology, Genetic and Metabolism, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China

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Huan-Min Wang Department of Surgical Oncology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China

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Pei-Pei Hui Department of Pediatric Endocrinology, Genetic and Metabolism, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China

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Xue-Jun Liang Department of Pediatric Endocrinology, Genetic and Metabolism, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China

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Jie Yan Department of Pediatric Endocrinology, Genetic and Metabolism, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China

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Yu-Jun Wu Department of Pediatric Endocrinology, Genetic and Metabolism, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China

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Yan-Mei Sang Department of Pediatric Endocrinology, Genetic and Metabolism, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China

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Cheng Zhu Department of Pediatric Endocrinology, Genetic and Metabolism, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China

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Gui-Chen Ni Department of Pediatric Endocrinology, Genetic and Metabolism, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China

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Congenital hyperinsulinism (CHI) is a kind of genetically heterogeneous disease, in which intractable, persistent hypoglycemia is induced by excessive insulin secretion and increased serum insulin concentration ( 1 ). To date, 14 genes ( ABCC8

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