Hypoglycemia: Incidence and Clinical Predictors in a Large Population-Based Sample of Children and Adolescents with IDDM

Davis, Elizabeth A.; Keating, Barbara; Byrne, G C; Russell, Michael L.; Jones, Timothy W.

doi:10.2337/diacare.20.1.22

Cited by 257 publications

(205 citation statements)

References 13 publications

Supporting

Mentioning

177

Contrasting

Unclassified

Order By: Relevance

“…Of the 585 patients, 186 experienced a total of 477 severe episodes with a total follow-up time of approximately 3,500 patientyears. The overall incidence rate of 14.0 per 100 patientyears is similar to the rate we have reported previously [2,22] and comparable with other studies [1,29,30]. A Swedish study reported an overall incidence rate of 17.0 per 100 patient-years [20], which is slightly higher than our study, and a median age of 12.8 years compared with 10 years in our study.…”

Section: Discussionsupporting

confidence: 91%

“…Longitudinal clinical data on these patients were collected prospectively from the time of diagnosis of diabetes. Princess Margaret Hospital is the only paediatric diabetes referral centre for diabetes in Western Australia, and all diagnosed children in the state are registered and treated there, thus achieving a 99% case ascertainment rate [22,23] with a very low drop-out rate (<4%). Western Australia has an estimated total population of approximately two million.…”

Section: Subjectsmentioning

confidence: 99%

See 1 more Smart Citation

The relationship between ACE genotype and risk of severe hypoglycaemia in a large population-based cohort of children and adolescents with type 1 diabetes

et al. 2007

View full text Add to dashboard Cite

Aims/hypothesis Genetic factors may account for familial clustering related to diabetes complications. Studies have shown a significant relationship between the presence of the deletion (D) allele of the gene encoding ACE and risk of severe hypoglycaemia. This large prospective cohort study assesses this relationship in a large sample of children and adolescents with type 1 diabetes. Subjects and methods We studied 585 children and adolescents (mean age 11.9±4 years, 48.4% males). The frequency of severe hypoglycaemia (an event leading to loss of consciousness or seizure) was prospectively assessed over the 13-year period 1992-2004. Patients were seen with their parents every 3 months and data recorded at each visit. The ACE gene was detected using PCR. Results In our cohort of 585 children, 186 (31.8%) had at least one episode of severe hypoglycaemia, and of these 28.0% had the II genotype, 48.9% had the ID genotype and 23.1% had the DD genotype. This was in agreement with the Hardy-Weinberg proportion. A total of 477 severe hypoglycaemic episodes was recorded with a total of 3,404 person-years of follow-up, giving a total incidence of 14 per 100 patient-years. No significant increase in risk for DD genotype (incidence rate ratio=0.97, 95% CI 0.61-1.55) relative to II genotype was observed. Conclusions/interpretation This large prospective study concludes that the presence of the D allele of the ACE gene does not predict a significantly higher risk of severe hypoglycaemia in type 1 diabetic children and adolescents.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Subjectsmentioning

confidence: 99%

The relationship between ACE genotype and risk of severe hypoglycaemia in a large population-based cohort of children and adolescents with type 1 diabetes

et al. 2007

View full text Add to dashboard Cite

show abstract

“…The night period, in particular, remains challenging with over 50% of severe hypoglycemic episodes occurring during sleep in children and adolescents [3]. An assembly of aggravating factors including reduced frequency of blood glucose self-monitoring, blunted sympathoadrenal response to falling blood glucose concentration, reduced hypoglycemia awareness, and reduced warning symptoms and arousal from sleep explain the propensity to nocturnal hypoglycemia [4].…”

Section: Introductionmentioning

confidence: 99%

“…An assembly of aggravating factors including reduced frequency of blood glucose self-monitoring, blunted sympathoadrenal response to falling blood glucose concentration, reduced hypoglycemia awareness, and reduced warning symptoms and arousal from sleep explain the propensity to nocturnal hypoglycemia [4]. Children and adolescents may be more likely to experience hypoglycemic seizures at nighttime [3]. Fear of hypoglycemia is the major barrier to therapy intensification [3], being also a major source of stress and anxiety for families and caregivers [5], affecting quality of life and psychological well-being of the young and families, and leading to suboptimal glucose control [6].…”

Section: Introductionmentioning

confidence: 99%

“…Children and adolescents may be more likely to experience hypoglycemic seizures at nighttime [3]. Fear of hypoglycemia is the major barrier to therapy intensification [3], being also a major source of stress and anxiety for families and caregivers [5], affecting quality of life and psychological well-being of the young and families, and leading to suboptimal glucose control [6]. …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Insulin delivery and nocturnal glucose control in children and adolescents with type 1 diabetes

Tauschmann

Hovorka

2017

Expert Opinion on Drug Delivery

View full text Add to dashboard Cite

Introduction: Nocturnal glucose control remains challenging in children and adolescents with type 1 diabetes due to highly variable overnight insulin requirements. The issue may be addressed by glucose responsive insulin delivery based on real-time continuous glucose measurements.Areas covered: This review outlines recent developments of glucose responsive insulin delivery systems from a paediatric perspective. We cover threshold-based suspend application, predictive low glucose suspend, and more advanced single hormone and dual-hormone closed-loop systems. Approaches are evaluated in relation to nocturnal glucose control particularly during outpatient randomised controlled trials.Expert opinion: Significant progress translating research from controlled clinical centre settings to free-living unsupervised home studies have been achieved over the past decade. Nocturnal glycaemic control can be improved whilst reducing the risk of hypoglycaemia with closed-loop systems. Following the US regulatory approval of the first hybrid closed-loop system in non-paediatric population, large multinational closed-loop clinical trials and pivotal studies including paediatric populations are underway or in preparation to facilitate the use of closed-loop systems in clinical practice.

show abstract

Effect of Sensor-Augmented Insulin Pump Therapy and Automated Insulin Suspension vs Standard Insulin Pump Therapy on Hypoglycemia in Patients With Type 1 Diabetes

Nicholas

Retterath

et al. 2013

JAMA

401

290

View full text Add to dashboard Cite

IMPORTANCE Hypoglycemia is a critical obstacle to the care of patients with type 1 diabetes. Sensor-augmented insulin pump with automated low-glucose insulin suspension has the potential to reduce the incidence of major hypoglycemic events.OBJECTIVE To determine the incidence of severe and moderate hypoglycemia with sensor-augmented pump with low-glucose suspension compared with standard insulin pump therapy. DESIGN, SETTING, AND PARTICIPANTSA randomized clinical trial involving 95 patients with type 1 diabetes, recruited from December 2009 to January 2012 in Australia.INTERVENTIONS Patients were randomized to insulin pump only or automated insulin suspension for 6 months. MAIN OUTCOMES AND MEASURESThe primary outcome was the combined incidence of severe (hypoglycemic seizure or coma) and moderate hypoglycemia (an event requiring assistance for treatment). In a subgroup, counterregulatory hormone responses to hypoglycemia were assessed using the hypoglycemic clamp technique. RESULTSOf the 95 patients randomized, 49 were assigned to the standard-pump (pump-only) therapy and 46 to the low-glucose suspension group. The mean (SD) age was 18.6 (11.8) years; duration of diabetes, 11.0 (8.9) years; and duration of pump therapy, 4.1 (3.4) years. The baseline rate of severe and moderate hypoglycemic events in the pump-only group was 20.7 vs 129.6 events per 100 patient months in the low-glucose suspension group. After 6 months of treatment, the event rates decreased from 28 to 16 in the pump-only group vs 175 to 35 in the low-glucose suspension group. The adjusted incidence rate per 100 patient-months was 34.2 (95% CI, 22.0-53.3) for the pump-only group vs 9.5 (95% CI, 5.2-17.4) for the low-glucose suspension group. The incidence rate ratio was 3.6 (95% CI, 1.7-7.5; P <.001). There was no change in glycated hemoglobin in either group: mean, 7.4 (95% CI, 7.2-7.6) to 7.4 (95% CI, 7.2-7.7) in the pump-only group vs mean, 7.6 (95%, CI, 7.4-7.9) to 7.5 (95% CI, 7.3-7.7) in the low-glucose suspension group. Counterregulatory hormone responses to hypoglycemia were not changed. There were no episodes of diabetic ketoacidosis or hyperglycemia with ketosis.CONCLUSIONS AND RELEVANCE Sensor-augmented pump therapy with automated insulin suspension reduced the combined rate of severe and moderate hypoglycemia in patients with type 1 diabetes.

show abstract

Hypoglycemia: Incidence and Clinical Predictors in a Large Population-Based Sample of Children and Adolescents with IDDM

Cited by 257 publications

References 13 publications

The relationship between ACE genotype and risk of severe hypoglycaemia in a large population-based cohort of children and adolescents with type 1 diabetes

The relationship between ACE genotype and risk of severe hypoglycaemia in a large population-based cohort of children and adolescents with type 1 diabetes

Insulin delivery and nocturnal glucose control in children and adolescents with type 1 diabetes

Effect of Sensor-Augmented Insulin Pump Therapy and Automated Insulin Suspension vs Standard Insulin Pump Therapy on Hypoglycemia in Patients With Type 1 Diabetes

Contact Info

Product

Resources

About