Hypoglycemia Prevalence in Prepubertal Children With Type 1 Diabetes on Standard Insulin Regimen: Use of Continuous Glucose Monitoring System

Abstract

OBJECTIVE -To determine hypoglycemia prevalence in prepubertal children on thrice (TID) and twice (BID) daily insulin regimens, using the Medtronic Minimed Continuous Glucose Monitoring System. RESEARCH DESIGN AND METHODS -Twenty-eight children aged Ͻ12 years (median 9.8, range 6.9 -11.8) wore the sensor for three consecutive days and nights. Hypoglycemia was defined as glucose Ͻ60 mg/dl for Ͼ15 min. Data are expressed as the percentage of time period spent hypoglycemic.RESULTS -Hypoglycemia prevalence was 10.1% (mean 2.6 h ⅐ subject Ϫ1 ⅐ day Ϫ1 ). Hypoglycemia was more common at night compared with daytime (18.81 vs. 4.4%, P Ͻ 0.001); 78 and 43% of subjects showed hypoglycemia on at least one night and two or more nights, respectively. Nocturnal episodes were prolonged (median 3.3 h) and asymptomatic (91% of episodes). Prevalence was greater between 0400 and 0730 h than between 2200 and 0400 h (25.5 vs. 15.4%, P Ͻ 0.001). On a TID compared with a BID regimen, nocturnal hypoglycemia prevalence was reduced, particularly between 0400 -0730 h (22.9 vs. 27.4%, P ϭ 0.005), whereas hypoglycemia the following morning (0730 -1200 h) was greater (7.8 vs. 2.8%, P Ͻ 0.001). Nocturnal hypoglycemia risk was associated with decreasing age (by a factor of 0.6 for a year less in age), increased insulin dose (by 1.6 for an increase of 0.1 units ⅐ kg Ϫ1 ⅐ day Ϫ1 ), insulin regimen (by 0.2 on a BID compared with a TID regimen), and increased weight standard deviation score (SDS) (by 2.7 for a one SDS rise).CONCLUSIONS -Use of standard insulin regimens results in high prevalence and large intraindividual variation in hypoglycemia, particularly at night. Independent risk factors for nocturnal hypoglycemia were younger age, greater daily insulin dose, insulin regimen, and increasing weight. Diabetes Care 26:662-667, 2003

Glycemic Characteristics in Continuously Monitored Patients With Type 1 and Type 2 Diabetes

“…hypoglycemic ϳ8% of the day, and this finding corroborates previously reported estimates of hypoglycemia prevalence (33). Importantly, however, these periods of hypoglycemia were more likely to occur nocturnally and were significantly more frequent among type 1 diabetic subjects.…”

Obesity and Sleep Disturbance in Children

“…Особенно плохо изучена ночная гипогликемия у детей, в сочетании с СД представляющая угрозу жизни ребенка [47]. В работе R. Amin показана высокая частота (78%) ночной гипогликемии у детей в возрасте до 12 лет, при этом в 91% случаев патологические состояния протекали без каких-либо клинических проявлений [48].…”

Dynamic changes in CD4+ CD25+ high T cell apoptosis after the diagnosis of type 1 diabetes

“…Depending on age, pubertal status, insulin sensitivity and criteria for partial remission, up to 60% of patients with T1D might experience a partial remission [4,16,[18][19][20][21]. Furthermore, partial remission has been shown to be a heterogeneous phenomenon with inter-and intraindividual variation [22] and factors such as diabetes care intensity and early identification of hyperglycaemic symptoms prior to diagnosis influencing its course [20]. While TDD, HbA1c and SMBGs have great value in everyday management of the disease, the addition of CD4 + CD25 +high T cell apoptosis assay brings a quantitative T cell component to the monitoring process.…”