Reduction in Diabetic Ketoacidosis and Severe Hypoglycemia in Pediatric Type 1 Diabetes During the First Year of Continuous Glucose Monitoring: A Multicenter Analysis of 3,553 Subjects From the DPV Registry

Tauschmann, Martin; Hermann, Julia; Freiberg, Clemens; Papsch, Matthias; Thon, A.; Heidtmann, Bettina; Placzeck, Kerstin; Agena, Dirk; Kapellen, Thomas; Schenk, Bernd; Wolf, Johannes; Danne, Thomas; Rami‐Merhar, Birgit; Holl, Reinhard W.; Initiative, Dpv

doi:10.2337/dc19-1358

Cited by 77 publications

(65 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…More than one‐half of our young adults used CGMs, significantly more patients who were diagnosed at an older age. CGM usage improves glycemic control, 29 the decreased HbA1c measured in the group diagnosed later may therefore reflect the increased usage of CGMs. Introduction of CGM technology in recent years has gained increasing popularity, and it is possible that patients who had been diagnosed before its introduction were more reluctant to use this device.…”

Section: Discussionmentioning

confidence: 99%

Association between age at type 1 diabetes diagnosis and metabolic outcome at young adulthood: a real‐life observational study

Goldberg

Brener

Levy

et al. 2020

Diabetes Metabolism Res

View full text Add to dashboard Cite

BackgroundYounger age at diagnosis of type 1 diabetes (T1D) may affect the clinical course and outcome. We examined whether age at diagnosis was associated with glycemic control and metabolic outcome in young adulthood.MethodsThis observational study included 105 young adults with T1D (current mean age: 21.2 ± 3.0 years, mean age at diagnosis 12.0 ± 4.0 years) followed during 2012 to 2019. Data on HbA1c, glucose variability, continuous glucose monitoring (CGM) metrics, body mass index (BMI), blood pressure (BP), and body composition were collected from medical records from age 18 years until last visit, and the association between age at diagnosis and outcomes was assessed.ResultsAge at T1D diagnosis was negatively associated with HbA1c levels (r = −0.368, P = .001), BMI (r = −0.218, P = .026), and diastolic BP (r = −0.215, P = .028). Younger age at diagnosis predicted poorer glycemic control after controlling for T1D duration, sex, socioeconomic status, BMI, and CGM use (r2 = 0.19, P = .002). There was a 0.1% greater HbA1c reduction for every yearly increase in age at diagnosis (β = −0.090, P = .042). The mean metabolic age of females diagnosed at <10 years of age was older than their chronological age (P = .049).ConclusionsYounger age at T1D diagnosis predicts worse glycemic control at young adulthood, independent of recognized confounding risk factors (disease duration, sex, socioeconomic status, weight, and use of diabetes technology). Female patients diagnosed at a young age have an older metabolic age, indicating the need for lifestyle alteration to improve their basal metabolic rate.

show abstract

Section: Discussionmentioning

confidence: 99%

Association between age at type 1 diabetes diagnosis and metabolic outcome at young adulthood: a real‐life observational study

Goldberg

Brener

Levy

et al. 2020

Diabetes Metabolism Res

View full text Add to dashboard Cite

show abstract

“…Our current training on use of the CGM glucose profile and data report is to always address any noted patterns of hypoglycemia first. This is a sound principle, and using CGM we have been extremely successful in minimizing hypoglycemia as demonstrated in randomized clinical trials (9-11) and cohort studies (12). Unfortunately, in routine clinical care, we often forget the word first in the CGM teaching principle of "address hypoglycemia first."…”

mentioning

confidence: 99%

Continuous Glucose Monitoring–Derived Data Report—Simply a Better Management Tool

Battelino

Bergenstal

2020

Diabetes Care

View full text Add to dashboard Cite

“…A randomized controlled multicenter study demonstrated reduction in time spent in hypoglycemia concomitant with a decrease in HbA 1c in both children and adults with type 1 diabetes ( 98 ). A multicenter analysis of 3,553 subjects from the German-Austrian-Swiss-Luxembourgian Diabetes Prospective Follow-up registry demonstrated that initiation and regular use of CGM in children and adolescents with type 1 diabetes were associated with reduction in both diabetic ketoacidosis and severe hypoglycemia with modest improvement in glycemic control ( 100 ). Although the use of CGM can decrease the episodes of severe hypoglycemia in adult patients ( 80 , 101 ), this effect is not elucidated in pediatric patients ( 102 ).…”

Section: Morbiditymentioning

confidence: 99%

Severe Hypoglycemia: Is It Still a Threat for Children and Adolescents With Type 1 Diabetes?

Urakami

2020

Front. Endocrinol.

View full text Add to dashboard Cite

Severe hypoglycemia is defined as a condition with serious cognitive dysfunction, such as a convulsion and coma, requiring external help from other persons. This condition is still lethal and is reported to be the cause of death in 4-10% in children and adolescents with type 1 diabetes. The incidence of severe hypoglycemia in the pediatric population was previously reported as high as more than 50-100 patient-years; however, there was a decline in the frequency of severe hypoglycemia during the past decades, and relationship with glycemic control became weaker than previously reported. A lot of studies have shown the neurological sequelae with severe hypoglycemia as cognitive dysfunction and abnormalities in brain structure. This serious condition also provides negative psychosocial outcomes and undesirable compensatory behaviors. Various possible factors, such as younger age, recurrent hypoglycemia, nocturnal hypoglycemia, and impaired awareness of hypoglycemia, are possible risk factors for developing severe hypoglycemia. A low HbA 1c level is not a predictable value for severe hypoglycemia. Prevention of severe hypoglycemia remains one of the most critical issues in the management of pediatric patients with type 1 diabetes. Advanced technologies, such as continuous glucose monitoring (CGM), intermittently scanned CGM, and sensor-augmented pump therapy with low-glucose suspend system, potentially minimize the occurrence of severe hypoglycemia without worsening overall glycemic control. Hybrid closed-loop system must be the most promising tool for achieving optimal glycemic control with preventing the occurrence of severe hypoglycemia in pediatric patients with type 1 diabetes.

show abstract

Reduction in Diabetic Ketoacidosis and Severe Hypoglycemia in Pediatric Type 1 Diabetes During the First Year of Continuous Glucose Monitoring: A Multicenter Analysis of 3,553 Subjects From the DPV Registry

Cited by 77 publications

References 5 publications

Association between age at type 1 diabetes diagnosis and metabolic outcome at young adulthood: a real‐life observational study

Association between age at type 1 diabetes diagnosis and metabolic outcome at young adulthood: a real‐life observational study

Continuous Glucose Monitoring–Derived Data Report—Simply a Better Management Tool

Severe Hypoglycemia: Is It Still a Threat for Children and Adolescents With Type 1 Diabetes?

Contact Info

Product

Resources

About