Severe hypoglycemia in children with insulin-dependent diabetes mellitus: Frequency and predisposing factors

Daneman, Denis; Frank, M; Perlman, Kusiel; Tamm, Judith; Ehrlich, Robert

doi:10.1016/s0022-3476(89)80642-0

Cited by 86 publications

(50 citation statements)

References 16 publications

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“…The rates of severe hypoglycemia are fairly comparable to those reported previously and may indicate a slight decline with duration (8,11,22). These rates are a conservative estimate of severe hypoglycemia because our study limited the definition to those who reported losing consciousness.…”

Section: Methodssupporting

confidence: 85%

Risk Factors for Frequent and Severe Hypoglycemia in Type 1 Diabetes

Allen

LeCaire²,

Palta³

et al. 2001

Diabetes Care

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FOR THE WISCONSIN DIABETES REGISTRY PROJECTOBJECTIVE -To determine the risk of frequent and severe hypoglycemia and the associated demographic and clinical risk factors.RESEARCH DESIGN AND METHODS -Demographic and diabetes self-management factors were measured in 415 subjects followed prospectively for 4 -6.5 years of type 1 diabetes duration as participants in a population-based incident cohort. Blood samples were collected up to three times yearly to test glycosylated hemoglobin (GHb) levels. Reports of frequent (2-4 times/week) and severe (lost consciousness) hypoglycemia as well as other diabetes selfmanagement data were collected by questionnaires.RESULTS -Frequent hypoglycemia was common (33 and 35% of participants reported this on the 4-and 6.5-year questionnaires, respectively), whereas severe hypoglycemia occurred much less often. Better glycemic control (odds ratio [OR] 1.3 per 2% decrease in GHb, 95% CI 1.1-1.5) and more frequent self-monitored blood glucose (1.5 per blood glucose check, 1.3-1.7) were independently related to frequent hypoglycemia. The association of frequent hypoglycemia with intensive insulin therapy increased with age. Better glycemic control (1.5 per 2% decrease in GHb, 1.2-2.0) and older age were related to severe hypoglycemic reactions. No sociodemographic factors other than age increased the risk of hypoglycemia.CONCLUSIONS -Frequent hypoglycemia was common in a population representing the full range of glycemic control in the community. Intensive insulin management and blood glucose monitoring independently predicted frequent but not severe hypoglycemia. This information may be useful for updating patients such that minor changes in diabetes management might decrease the daily burden of this condition while maintaining intensive insulin therapy. Diabetes Care 24:1878 -1881, 2001H ypoglycemia is the most common acute complication of type 1 diabetes (1). Onset is usually rapid, and symptoms range from very mild to severe enough to cause brain damage or death (2,3). Results of the Diabetes Control and Complications Trial (DCCT) (4) increased emphasis on intensive insulin treatment but also drew attention to the accompanying risk of hypoglycemia with such therapy, particularly in adolescents.The frequency of and risk factors for moderate and/or severe hypoglycemia in young adults were described in studies conducted in clinic-or hospital-based samples (5-8), the DCCT (9), one national cross-sectional study from France, and a limited number of populationbased cohort studies (10 -12). From these studies, it is clear that a history of hypoglycemia (6,9,13) and intensive insulin therapy (9) is an important predictor.Findings regarding other factors such as age, sex, duration of diabetes, and glycemic control are not consistent across studies. The frequency of all levels of hypoglycemia has not been reported. Also, no large population-based cohort has been studied prospectively to determine the relationship of both intensive insulin therapy and glycemic control to frequent and severe hy...

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Section: Methodssupporting

confidence: 85%

Risk Factors for Frequent and Severe Hypoglycemia in Type 1 Diabetes

Allen

LeCaire²,

Palta³

et al. 2001

Diabetes Care

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“…The average incidence of 6.5 % per year is strikingly similar to that of two recent surveys in childhood diabetes [18,19], and considerably lower than that in two others [20,21] (Table 4), but these rates are notoriously difficult to compare. Egger et al [18] reported a rising incidence of severe hypoglycaemia in a Swiss paediatric diabetic clinic, from 4.4 per 100 patient years from 1981 to 1984 to 7.4 per 100 patient years from 1985 to 1988.…”

Section: Discussionsupporting

confidence: 74%

Presentation and progress of childhood diabetes mellitus: a prospective population-based study

et al. 1994

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SummaryWe surveyed the clinical presentation, initial management and subsequent course of a prospectively registered, population-based cohort of 230 patients with Type 1 (insulin-dependent) diabetes mellitus diagnosed before age 21 years in the Oxford Regional Health Authority area in 1985 and 1986. Clinical details from the time of diagnosis were available on 219 patients. Thirty-four (16 %) were in severe ketoacidosis with pH less than 7.10 or plasma bicarbonate less than 10 retool/l, and 21 (10 %) had mild to moderate ketoacidosis with pH 7.10-7.35 or plasma bicarbonate 10-21 mmol/1. One child died in ketoacidosis. Presentation in severe ketoacidosis was most common in children under age 5 years (p < 0.05), and ketoacidosis of any degree was less frequent in older children (0.05 < p < 0.01) and those with a parent or sibling with diabetes (p < 0.01). Withi n 4 years of diagnosis, 55 of 211patients (26%) experienced severe hypoglycaemia, which in 31 (15 % ) led to one or more admissions. Readmission for unstable glycaemic control excluding acute hypoglycaemia occurred at least once within 1 year of diagnosis in 13 % and within 4 years in 28 %, and was more common in girls, in children aged less than 10 years at diagnosis, and those with a history of severe hypoglycaemia. A second cohort of 97 similar patients was recruited in 1990. The rates of admission at diagnosis (79 %), severe ketoacidosis (13 %) and mild to moderate ketoacidosis (13 %) did not differ from the 1985/1986 cohort. Despite recent developments in diabetes management and a high level of clinical commitment at participating centres, ketoacidosis remains a common presentation of childhood diabetes, and hypoglycaemia is unacceptably frequent in the years following diagnosis. Greater public and medical awareness of the presenting features of diabetes in young children is needed to reduce the frequency of ketoacidosis at presentation, while hypoglycaemia remains a major obstacle to good glycaemic control. [Diabetologia (1994) 37: 70-74]

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“…Some investi gators have reported number of episodes per patient-year or per 100 patient-years [2,5,7,9], while others reported number of patients experiencing severe hypoglycaemia per year or per 100 patient-years [1,4,6,10]. l hus, in order to compare the data reported in the studies in ta ble 1, we have calculated both number of patients experi encing severe hypoglycaemia per 100 patient-years and the number of episodes per 100 patient-years whenever the published results permitted such calculations.…”

Section: Problems With the Numerator Of Frequency Calculationsmentioning

confidence: 99%

The Frequency of Severe Hypoglycaemia in Children with Insulin-Dependent Diabetes Mellitus

Clarke¹,

Gonder-Frederick²,

Cox³

1996

Horm Res

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The literature contains numerous reports of the frequency of severe hypoglycaemia in childhood insulin-dependent diabetes mellitus. Unfortunately, most of these data have been collected in such a manner as to make comparisons between them difficult. Most reports have used small, well-defined populations of children who were participants in larger, complex, clinical studies. Additional difficulties are encountered in the standardization of the definition of severe hypoglycaemia. Some studies have required that the child lose consciousness while others also included children who required assistance with treatment. Even when studies clearly define the representative nature of their patient population and include universally acceptable criteria for identifying a severe hypoglycaemic episode, the frequency of severe hypoglycaemia must be qualified. Severe hypoglycaemia is generated by a series of complex biological, psychological, and behavioural processes. Its frequency must be viewed not as a fixed value, but rather as a dynamic dependent variable.

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Severe hypoglycemia in children with insulin-dependent diabetes mellitus: Frequency and predisposing factors

Cited by 86 publications

References 16 publications

Risk Factors for Frequent and Severe Hypoglycemia in Type 1 Diabetes

Risk Factors for Frequent and Severe Hypoglycemia in Type 1 Diabetes

Presentation and progress of childhood diabetes mellitus: a prospective population-based study

The Frequency of Severe Hypoglycaemia in Children with Insulin-Dependent Diabetes Mellitus

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