Diabetes Care, Vol 20, Issue 1 22-25, Copyright © 1997 by American Diabetes Association

ARTICLES

Hypoglycemia: incidence and clinical predictors in a large population-based sample of children and adolescents with IDDM

EA Davis, B Keating, GC Byrne, M Russell and TW Jones
Department of Diabetes and Endocrinology, Princess Margaret Hospital for Children, Perth, Western Australia.

OBJECTIVE: To determine the frequency of moderate and severe hypoglycemia and to identify clinical predictors associated with its occurrence in a large population-based sample of children and adolescents with IDDM. RESEARCH DESIGN AND METHODS: A total of 657 patients (age: 12.1 +/- 4.4 years, mean +/- SD) were included in the study, yielding 1,449 patient-years of data. A prospective assessment of severe hypoglycemia (an event resulting in a seizure or coma) and moderate hypoglycemia (an event requiring assistance of another, excluding severe episodes) was made over a 3-year period. Patients and caregivers detailed episodes of significant hypoglycemia (moderate and severe events) and these were recorded at each 3-month clinic visit along with HbA1c. Data were analyzed using generalized estimating equation models fitted with the exchange correlation structure. RESULTS: The overall incidence of severe events was 4.8/100 patient-years and of moderate events was 13.1/100 patient-years. Over 3 years, severe events occurred in 8.5% of children and moderate events occurred in 26.9%. Significant hypoglycemia was rare in the first 12 months after diagnosis. Rates of hypoglycemia were increased in children < 6 years of age versus > 6 years of age (40.9 vs. 16.6/100 patient-years, age < or = 6 years vs. age > 6 years, P < 0.001). Rates of hypoglycemia doubled when HbA1c fell below 8%, and children with HbA1c < 7% had a threefold increase in both moderate and severe hypoglycemia (e.g., severe episodes 14.9 vs. 4.1/100 patient-years, HbA1c < or = 7% vs. HbA1c > 7%, P < 0.001). Most severe events were seizures, and 75% of them occurred at night. The majority of events were related to missed meals or increased activity. However, in 38% no predisposing factor was evident. CONCLUSIONS: Newly diagnosed children appear to be protected from severe hypoglycemia. Rates increase with lower glycated hemoglobin, especially when mean HbA1c is < 8.0%. Younger children, who may be more susceptible to the adverse effects of neuroglycopenia, are at a particular risk of significant hypoglycemia.
CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				B. Buckingham, D. M. Wilson, T. Lecher, R. Hanas, K. Kaiserman, and F. Cameron Duration of Nocturnal Hypoglycemia Before Seizures Diabetes Care, November 1, 2008; 31(11): 2110 - 2112. [Abstract] [Full Text] [PDF]

				L. C. Perlmuter, B. P. Flanagan, P. H. Shah, and S. P. Singh Glycemic Control and Hypoglycemia: Is the loser the winner? Diabetes Care, October 1, 2008; 31(10): 2072 - 2076. [Full Text] [PDF]

				L. Velisek, J. Veliskova, O. Chudomel, K.-L. Poon, K. Robeson, B. Marshall, A. Sharma, and S. L. Moshe Metabolic Environment in Substantia Nigra Reticulata Is Critical for the Expression and Control of Hypoglycemia-Induced Seizures J. Neurosci., September 17, 2008; 28(38): 9349 - 9362. [Abstract] [Full Text] [PDF]

				J. M. Block and B. Buckingham Use of Real-Time Continuous Glucose Monitoring Technology in Children and Adolescents Diabetes Spectr, April 1, 2008; 21(2): 84 - 90. [Abstract] [Full Text] [PDF]

				W. V. Tamborlane Triple Jeopardy: Nocturnal Hypoglycemia after Exercise in the Young with Diabetes J. Clin. Endocrinol. Metab., March 1, 2007; 92(3): 815 - 816. [Full Text] [PDF]

				S. K. McMahon, L. D. Ferreira, N. Ratnam, R. J. Davey, L. M. Youngs, E. A. Davis, P. A. Fournier, and T. W. Jones Glucose Requirements to Maintain Euglycemia after Moderate-Intensity Afternoon Exercise in Adolescents with Type 1 Diabetes Are Increased in a Biphasic Manner J. Clin. Endocrinol. Metab., March 1, 2007; 92(3): 963 - 968. [Abstract] [Full Text] [PDF]

				H. P. Chase Nocturnal Hypoglycemia-- An Unrelenting Problem J. Clin. Endocrinol. Metab., June 1, 2006; 91(6): 2038 - 2039. [Full Text] [PDF]

				P. Boileau, B. Aboumrad, and P. Bougneres Recurrent Comas Due to Secret Self-Administration of Insulin in Adolescents With Type 1 Diabetes Diabetes Care, February 1, 2006; 29(2): 430 - 431. [Full Text] [PDF]

				T. Hershey, D. C. Perantie, S. L. Warren, E. C. Zimmerman, M. Sadler, and N. H. White Frequency and Timing of Severe Hypoglycemia Affects Spatial Memory in Children With Type 1 Diabetes Diabetes Care, October 1, 2005; 28(10): 2372 - 2377. [Abstract] [Full Text] [PDF]

				D. J. Cox, B. P. Kovatchev, L. A. Gonder-Frederick, K. H. Summers, A. McCall, K. J. Grimm, and W. L. Clarke Relationships Between Hyperglycemia and Cognitive Performance Among Adults With Type 1 and Type 2 Diabetes Diabetes Care, January 1, 2005; 28(1): 71 - 77. [Abstract] [Full Text] [PDF]

				S. A. Weinzimer, J. H. Ahern, E. A. Doyle, M. R. Vincent, J. Dziura, A. T. Steffen, and W. V. Tamborlane Persistence of Benefits of Continuous Subcutaneous Insulin Infusion in Very Young Children With Type 1 Diabetes: A Follow-up Report Pediatrics, December 1, 2004; 114(6): 1601 - 1605. [Abstract] [Full Text] [PDF]

				M. K. Bulsara, C. D. J. Holman, E. A. Davis, and T. W. Jones The Impact of a Decade of Changing Treatment on Rates of Severe Hypoglycemia in a Population-Based Cohort of Children With Type 1 Diabetes Diabetes Care, October 1, 2004; 27(10): 2293 - 2298. [Abstract] [Full Text] [PDF]

				R. Amin, K. Ross, C. L. Acerini, J. A. Edge, J. Warner, and D. B. Dunger Hypoglycemia Prevalence in Prepubertal Children With Type 1 Diabetes on Standard Insulin Regimen: Use of Continuous Glucose Monitoring System Diabetes Care, March 1, 2003; 26(3): 662 - 667. [Abstract] [Full Text] [PDF]

				C. Allen, T. LeCaire, M. Palta, K. Daniels, M. Meredith, and D. J. D'Alessio Risk Factors for Frequent and Severe Hypoglycemia in Type 1 Diabetes Diabetes Care, November 1, 2001; 24(11): 1878 - 1881. [Abstract] [Full Text] [PDF]

				T. P.C. Monsod, W. V. Tamborlane, L. Coraluzzi, M. Bronson, T. Yong-Zhan Ma, and J. A. Ahern Epipen as an Alternative to Glucagon in the Treatment of Hypoglycemia in Children With Diabetes Diabetes Care, April 1, 2001; 24(4): 701 - 704. [Abstract] [Full Text]

				L. E. Rafkin-Mervis and J. B. Marks The Science of Diabetic Snack Bars: A Review Clin. Diabetes, January 1, 2001; 19(1): 4 - 12. [Abstract] [Full Text] [PDF]

				S. B. Johnson, A. R. Perwien, and J. H. Silverstein Response to Hypo- and Hyperglycemia in Adolescents With Type I Diabetes J. Pediatr. Psychol., April 1, 2000; 25(3): 171 - 178. [Abstract] [Full Text] [PDF]

				T. W. Jones, P. Porter, R. S. Sherwin, E. A. Davis, P. O'Leary, F. Frazer, G. Byrne, S. Stick, and W. V. Tamborlane Decreased Epinephrine Responses to Hypoglycemia during Sleep N. Engl. J. Med., June 4, 1998; 338(23): 1657 - 1662. [Abstract] [Full Text] [PDF]