A population-based study of risk factors for severe hypoglycaemia in a contemporary cohort of childhood-onset type 1 diabetes

Abstract

Aims/hypothesis Severe hypoglycaemia is a major barrier to optimising glycaemic control. Recent changes in therapy, however, may have altered the epidemiology of severe hypoglycaemia and its associated risk factors. The aim of this study was to examine the incidence rates and risk factors associated with severe hypoglycaemia in a contemporary cohort of children and adolescents with type 1 diabetes. Methods Subjects were identified from a population-based register containing data on >99% of patients (<16 years of age) who were being treated for type 1 diabetes in Western Australia. Patients attend the clinic approximately every 3 months, where data pertaining to diabetes management, demographics and complications including hypoglycaemia are prospectively recorded. A severe hypoglycaemic event was defined as an episode of coma or convulsion associated with hypoglycaemia. Risk factors assessed included age, duration of diabetes, glycaemic control, sex, insulin therapy, socioeconomic status and calendar year.Results Clinical visit data from 1,770 patients, providing 8,214 patient-years of data between 2000 and 2011 were analysed. During follow-up, 841 episodes of severe hypoglycaemia were observed. No difference in risk of severe hypoglycaemia was observed between age groups. Good glycaemic control (HbA 1c <7% [53 mmol/mol]) compared with the cohort average (HbA 1c 8-9% [64-75 mmol/mol]) was not associated with an increased risk of severe hypoglycaemia. When compared with patients on injection regimens, subjects aged 12-18 years on pump therapy were at reduced risk of severe hypoglycaemia (incidence risk ratio 0.6; 95% CI 0.4, 0.9). Conclusions/interpretation In this population-based sample of children and adolescents with type 1 diabetes, contemporary therapy is associated with a changed pattern and incidence of severe hypoglycaemia.

Contrasting the clinical care and outcomes of 2,622 children with type 1 diabetes less than 6 years of age in the United States T1D Exchange and German/Austrian DPV registries

“…Consequently, one of the most important findings of the study was the demonstration that the lower ISPAD target of HbA 1c levels <7.5% (<58 mmol/mol) was achieved in the majority of DPV patients without increasing the risk of SH. Other current reports in children and adults support the achievement of an HbA 1c <7% (<53 mmol/mol) or <7.5% (<58 mmol/mol) without an increase in SH [11,12,20]. There is an increasing body of evidence that DKA and hyperglycaemia per se, in addition to hypoglycaemia, can have adverse effects on the developing brains of young children [21][22][23].…”

Standards of Medical Care in Diabetes—2014

“…Children and Adolescents (501). In adolescents, the DCCT demonstrated that near-normalization of blood glucose levels was more difficult to achieve compared with adults.…”

Minimizing Hypoglycemia in Diabetes

“…CSII may be better than MDI in selected, capable, and motivated patients with hypoglycemiaprone diabetes (70,78) largely because of the premise that CSII may reduce A1C to some extent without increasing the risk of hypoglycemia. One meta-analysis concluded that compared with MDI, CSII reduces hypoglycemia, but this conclusion was based on three randomized controlled trials using an NPH or lente insulin-based MDI regimen (79); trials using insulin analog MDI comparison groups have not reported lower rates of hypoglycemia with CSII (80)(81)(82).…”