Continuous determination of blood glucose in children admitted with malaria in a rural hospital in Mozambique

Abstract

BackgroundHypoglycaemia is a frequent complication among admitted children, particularly in malaria-endemic areas. This study aimed to estimate the occurrence of hypoglycaemia not only upon admission but throughout the first 72 h of hospitalization in children admitted with malaria.MethodsA simple pilot study to continuously monitor glycaemia in children aged 0–10 years, admitted with malaria in a rural hospital was conducted in Southern Mozambique by inserting continuous glucose monitors (CGMs) in subcutaneous tissue of the abdominal area, producing glycaemia readings every 5 min.ResultsGlucose was continuously monitored during a mean of 48 h, in 74 children. Continuous measurements of blood glucose were available for 72/74 children (97.3%). Sixty-five of them were admitted with density-specific malaria diagnosis criteria (17 severe, 48 uncomplicated). Five children (7.7%) had hypoglycaemia (<54 mg/dL) on admission as detected by routine capillary determination. Analysing the data collected by the CGMs, hypoglycaemia episodes (<54 mg/dL) were detected in 10/65 (15.4%) of the children, of which 7 (10.8%) could be classified as severe (≤45 mg/dL). No risk factors were independently associated with the presence of at least one episode of hypoglycaemia (<54 mg/dL) during hospitalization. Only one death occurred among a normoglycaemic child. All episodes of hypoglycaemia detected by CGMs were subclinical episodes or not perceived by caregivers or clinical staff.ConclusionsHypoglycaemia beyond admission in children with malaria appears to be much more frequent than what had been previously described. The clinical relevance of these episodes of hypoglycaemia in the medium or long term remains to be determined.

Blood Glucose Concentration Abnormalities in Children with Severe Malaria: Risk Factors and Outcome

“…In the present study, no case of relapse of severe hypoglycemia was observed after admission, unlike some authors who reported a relatively large number of cases [13] [28] [29]. It is difficult to make a relevant analysis of our results, because of the low number of cases of severe hypoglycemia.…”

“…However, Madrid et al in Mozambique found a higher incidence of hypoglycemia than hyperglycemia on admission and the same frequency of both abnormalities after admission [13]. This difference is related to the fact that the Madrid study population was composed of children with uncomplicated and severe malaria, and the definition of hyperglycemia (blood glucose ≥ 11.0 mmol/L) [13] was different from the one used in our study (blood glucose ≥ 8.3 mmol/L).…”

“…But, the frequency of hyperglycemia was less important in the Wilcox study, probably because blood glucose had been measured only on admission [12]; hyperglycemia in malaria is a stress hyperglycemia, it is secondary to the increase in glucose production during severe malaria through gluconeogenesis and glycogenolysis [20] [22] [23] [24]. However, Madrid et al in Mozambique found a higher incidence of hypoglycemia than hyperglycemia on admission and the same frequency of both abnormalities after admission [13]. This difference is related to the fact that the Madrid study population was composed of children with uncomplicated and severe malaria, and the definition of hyperglycemia (blood glucose ≥ 11.0 mmol/L) [13] was different from the one used in our study (blood glucose ≥ 8.3 mmol/L).…”

“…On the other hand, few studies have been devoted to other glycemic disorders during severe malaria. Thus hyperglycemia yet recognized as factor of poor outcome in critically ill children [9] [10] [11], has been less investigated during malaria, the same notice is made for moderate hypoglycemia [12] [13]. In a study on severe malaria in Mali, Wilcox found an increased risk of death in both groups severe and moderate hypoglycemia, while hyperglycemia had a protective role over death [12].…”

Dysglycemia in Children with Severe Acute Malnutrition: A Systematic Review and Meta-Analysis

“…The exact patterns of glycemia in SAM remain largely unknown ( 37 ), and in high-resource contexts it is reported that glucose variability is associated with increased mortality in sick children ( 36 ). A way of investigating the patterns of blood glucose concentrations and identifying any episodes of asymptomatic hypoglycemia is using a continuous glucose monitoring system.These have been used in very low birth weight infants ( 38 ) and children with malaria where over 15% of children with hypoglycemia were asymptomatic ( 39 ). Continuous glucose monitoring systems have not been used in children with SAM before, and could provide valuable insights into the occurrence, risk factors, and clinical impact of dysglycemia in these children.…”