Prevalence and predictors of severe hypoglycemia in Danish children and adolescents with diabetes

Johansen, Anders; Kanijo, B; Fredheim, Siri; Olsen, Birthe Susanne; Hertz, Birgitte; Lauridsen, Mette Høj; Andersen, Marie Louise Max; Mortensen, Henrik B.; Svensson, Jannet

doi:10.1111/pedi.12171

Cited by 25 publications

(32 citation statements)

References 29 publications

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“…Therefore, it is assumed that inpatient treatment at diabetes onset is the main cause for the variance in ORs for hospitalization between age groups in our analysis. Another contributing factor could be that events of severe hypoglycemia are more frequent in younger children . The age‐group >5 to 10 years includes children starting school.…”

Section: Discussionmentioning

confidence: 99%

Hospital admission in children and adolescents with or without type 1 diabetes from Germany: An analysis of statutory health insurance data on 12 million subjects

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Hospital admission in children and adolescents with or without type 1 diabetes from Germany: An analysis of statutory health insurance data on 12 million subjects

et al. 2017

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“…We have demonstrated that metabolic control has improved7 and severe hypoglycemic events have decreased 8,9. Furthermore, diabetic ketoacidosis at disease onset is associated with worse metabolic control and higher daily insulin requirement for equal HbA1c values (ie, higher insulin dose-adjusted [IDA]A1c)10 several years after diagnosis 11…”

Section: Examples Of Researchmentioning

confidence: 99%

Danish Registry of Childhood and Adolescent Diabetes

Svensson¹,

Cerqueira²,

Kjærsgaard³

et al. 2016

CLEP

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AimThe aims of the Danish Registry of Childhood and Adolescent Diabetes (DanDiabKids) are to monitor and improve the quality of care for children and adolescents with diabetes in Denmark and to follow the incidence and prevalence of diabetes.Study populationThe study population consists of all children diagnosed with diabetes before the age of 15 years since 1996. Since 2015, every child followed up at a pediatric center (<18 years of age) will be included.Main variablesThe variables in the registry are the quality indicators, demographic variables, associated conditions, diabetes classification, family history of diabetes, growth parameters, self-care, and treatment variables. The quality indicators are selected based on international consensus of measures of good clinical practice. The indicators are metabolic control as assessed by HbA1c, blood pressure, albuminuria, retinopathy, neuropathy, number of severe hypoglycemic events, and hospitalization with ketoacidosis.Descriptive dataThe number of children diagnosed with diabetes is increasing with ∼3% per year mainly for type 1 diabetes (ie, 296 new patients <15 years of age were diagnosed in 2014). The disease management has changed dramatically with more children treated intensively with multiple daily injections, insulin pumps, and increased number of self-monitored blood glucose values per day. These initiatives have resulted in a significant improvement in HbA1c over the years and a decrease in the number of children experiencing severe hypoglycemia, diabetic nephropathy, and retinopathy.ConclusionThe systematic collection of data in DanDiabKids documents improved quality of care over the last 12 years, despite a substantial increase in the number of patients cared for by pediatric departments in Denmark, fulfilling the purpose of the registry.

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“…For example, the Hvidøre study found the rate of SH to be 5.4 per 100 PY for CSII compared with 42.4 per 100 PY for conventional insulin therapy (freemix) ( P = .001) . In other studies, insulin pump therapy reduced the risk of SH compared with insulin pen therapy by 42% over 11 years ( P = .01), and by 27% over 5 years ( P = .003); the rate of SH in pump users was 89% lower than that in patients treated with premixed human insulin ( P = .0015), and 63% lower than that in patients treated with NPH ( P = .0031) …”

Section: Discussionmentioning

confidence: 98%

“…The degree of metabolic control had a notably variable effect on SH incidence (Tables ). Several studies documented no significant link between HbA1c level and SH incidence, whereas others reported the risk of SH to be higher at lower HbA1c levels or lower at higher HbA1c levels . For example, in 657 patients in Australia, HbA1c <7% was associated with an approximate 3‐fold increase in SH incidence from 4.1 to 14.9 per 100 PY ( P < .001) .…”

Section: Discussionmentioning

confidence: 99%

Incidence of severe hypoglycemia and possible associated factors in pediatric patients with type 1 diabetes mellitus in the real‐life, post‐DCCT setting: a systematic review

Cherubini¹,

Rabbone

Lombardo

et al. 2019

Pediatr Diabetes

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Background/Objective In 1993, the Diabetes Control and Complications Trial (DCCT) found that intensive antihyperglycemic therapy was effective in the primary and secondary prevention of microvascular complications in patients with type 1 diabetes (T1D) but was associated with a 3‐fold greater rate of severe hypoglycemia (SH) than conventional therapy. The aim of this analysis was to determine whether, in the real‐world setting, the incidence of SH in pediatric patients with T1D has changed since 1993. Methods A systematic literature search of PubMed for prospective or retrospective observational studies (≥250 participants) on SH epidemiology or related topics in pediatric patients with T1D, published between October 1993 and June 2016, identified 35 articles (involving >55 000 participants). SH incidence data were analyzed in approximate 5‐year blocks: 1993‐2000, 2001‐2005, 2006‐2010, and 2011‐2016. Information on factors that might influence the incidence of SH was also collected. Results A trend for a marked reduction in the incidence of SH in the post‐DCCT setting (from 62.0 per 100 patient‐years to 1.21‐30 per 100 patient‐years) was apparent. Factors that could have influenced this temporal trend in SH incidence included the increased use of new types of, and methods of administering, insulin, in particular rapid‐acting insulin analogs and continuous subcutaneous insulin infusion. Conclusions SH in pediatric patients with T1D has declined in incidence since the DCCT but remains a common problem. The optimal use of new insulin therapies/regimens/technologies, improved education, and dedicated specialized management teams are needed to help reduce the risk of SH in this population.

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Prevalence and predictors of severe hypoglycemia in Danish children and adolescents with diabetes

Cited by 25 publications

References 29 publications

Hospital admission in children and adolescents with or without type 1 diabetes from Germany: An analysis of statutory health insurance data on 12 million subjects

Hospital admission in children and adolescents with or without type 1 diabetes from Germany: An analysis of statutory health insurance data on 12 million subjects

Danish Registry of Childhood and Adolescent Diabetes

Incidence of severe hypoglycemia and possible associated factors in pediatric patients with type 1 diabetes mellitus in the real‐life, post‐DCCT setting: a systematic review

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