Severe hypoglycemia rates are not associated with HbA1c: a cross-sectional analysis of 3 contemporary pediatric diabetes registry databases

Abstract

An inverse relationship between mean HbA1c and risk of severe hypoglycemia was not observed in this study of 3, independent cohorts of children and adolescents with type 1 diabetes. Investigation in other large, longitudinal cohorts is recommended to further characterize the contemporary relationship between glycemic control and risk of severe hypoglycemia rates in pediatric patients with type 1 diabetes.

Incidence of severe hypoglycemia in children with type 1 diabetes in the Nordic countries in the period 2008–2012: association with hemoglobin A1cand treatment modality

“…20 Thus, during the last two decades, there has been a shift from a strong negative association between HbA 1c and SH 4 5 to nearly no association, 11 21 and finally, no association between HbA 1c and SH as demonstrated in our study and the new multicenter study including four countries. 13 In accordance with the Australian and the DPV study, 11 20 we did not find any association between gender and SH. We did not find any association between age and SH in accordance with the Australian study, 21 in contrast to the DPV study, 11 but the age ranges in the two studies were 1-18 years 21 and 1-20 years, 11 respectively.…”

ISPAD Clinical Practice Consensus Guidelines 2018: Assessment and management of hypoglycemia in children and adolescents with diabetes

“…The former strong association of low HbA1c with severe hypoglycemia is no longer as evident and low HbA1c is not a strong predictor of severe hypoglycemia in young patients with type 1 diabetes . This observation was further confirmed across international registries with a severe hypoglycemia rate per 100 patient years of 7.1, 3.3, and 6.7 in the American (Type 1 diabetes Exchange), German/Austrian (DPV), and Western Australian children’s diabetes database (WACDD), respectively, with no association with glycemic control . This trend was also demonstrated in the Nordic countries and can be attributed to a number of factors including increased use of insulin analogues and insulin pump therapy and improved hypoglycemia education .…”

“…Severe hypoglycemic coma is defined as a subgroup of severe hypoglycemia, as an event associated with a seizure or loss of consciousness (E). The incidence of severe hypoglycemic coma has fallen over the last 2 decades with a current rate of 3 to 7 per 100 patient years across international registries. Although lower hemoglobin A1c (HbA1c) was a risk factor for severe hypoglycemia, this association is no longer observed with contemporary therapy in recent surveys (B) Young children remain at risk of severe hypoglycemia due to their reduced ability to communicate their need (B) …”

ISPAD Clinical Practice Consensus Guidelines 2018: Glycemic control targets and glucose monitoring for children, adolescents, and young adults with diabetes

“…Severe hypoglycemia, particularly in young children, is associated with adverse neurocognitive effects . Historically, lower HbA1c values were associated with more frequent acute episodes of severe hypoglycemia, but more recent observational studies in the era of multiple daily injections, pumps, and more intensive glucose monitoring, including use of CGM, suggest this is not as significant a risk . Importantly, recent data suggest that lowering HbA1c targets is associated with a decreased mean HbA1c on a population and individual level without an increased frequency of severe hypoglycemia, even in children who achieve HbA1c levels <53 mmol/mol (7.0%) …”