Increasing Incidence of Hypoglycemic Coma in Children With IDDM

Egger, Matthias; Gschwend, Sylvia; Smith, George Davey; Zuppinger, K

doi:10.2337/diacare.14.11.1001

Cited by 46 publications

(36 citation statements)

References 20 publications

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“…The average incidence of 6.5 % per year is strikingly similar to that of two recent surveys in childhood diabetes [18,19], and considerably lower than that in two others [20,21] (Table 4), but these rates are notoriously difficult to compare. Egger et al [18] reported a rising incidence of severe hypoglycaemia in a Swiss paediatric diabetic clinic, from 4.4 per 100 patient years from 1981 to 1984 to 7.4 per 100 patient years from 1985 to 1988. This increase corresponded to a change to intensified insulin therapy, and lower mean HbA1 levels.…”

Section: Discussionsupporting

confidence: 75%

Presentation and progress of childhood diabetes mellitus: a prospective population-based study

et al. 1994

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SummaryWe surveyed the clinical presentation, initial management and subsequent course of a prospectively registered, population-based cohort of 230 patients with Type 1 (insulin-dependent) diabetes mellitus diagnosed before age 21 years in the Oxford Regional Health Authority area in 1985 and 1986. Clinical details from the time of diagnosis were available on 219 patients. Thirty-four (16 %) were in severe ketoacidosis with pH less than 7.10 or plasma bicarbonate less than 10 retool/l, and 21 (10 %) had mild to moderate ketoacidosis with pH 7.10-7.35 or plasma bicarbonate 10-21 mmol/1. One child died in ketoacidosis. Presentation in severe ketoacidosis was most common in children under age 5 years (p < 0.05), and ketoacidosis of any degree was less frequent in older children (0.05 < p < 0.01) and those with a parent or sibling with diabetes (p < 0.01). Withi n 4 years of diagnosis, 55 of 211patients (26%) experienced severe hypoglycaemia, which in 31 (15 % ) led to one or more admissions. Readmission for unstable glycaemic control excluding acute hypoglycaemia occurred at least once within 1 year of diagnosis in 13 % and within 4 years in 28 %, and was more common in girls, in children aged less than 10 years at diagnosis, and those with a history of severe hypoglycaemia. A second cohort of 97 similar patients was recruited in 1990. The rates of admission at diagnosis (79 %), severe ketoacidosis (13 %) and mild to moderate ketoacidosis (13 %) did not differ from the 1985/1986 cohort. Despite recent developments in diabetes management and a high level of clinical commitment at participating centres, ketoacidosis remains a common presentation of childhood diabetes, and hypoglycaemia is unacceptably frequent in the years following diagnosis. Greater public and medical awareness of the presenting features of diabetes in young children is needed to reduce the frequency of ketoacidosis at presentation, while hypoglycaemia remains a major obstacle to good glycaemic control. [Diabetologia (1994) 37: 70-74]

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Section: Discussionsupporting

confidence: 75%

Presentation and progress of childhood diabetes mellitus: a prospective population-based study

et al. 1994

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“…As can be seen in table 1. patient populations vary dramatically from study to study, with the only common factors among these reports being: (1) children, and (2) 1DDM [1][2][3][4][5][6][7][8][9][10],…”

Section: Problems With the Denominator Of Frequency Calculationsmentioning

confidence: 99%

“…Some investi gators have reported number of episodes per patient-year or per 100 patient-years [2,5,7,9], while others reported number of patients experiencing severe hypoglycaemia per year or per 100 patient-years [1,4,6,10]. l hus, in order to compare the data reported in the studies in ta ble 1, we have calculated both number of patients experi encing severe hypoglycaemia per 100 patient-years and the number of episodes per 100 patient-years whenever the published results permitted such calculations.…”

Section: Problems With the Numerator Of Frequency Calculationsmentioning

confidence: 99%

“…The DCCT definition of severe hypoglycaemia includes stupor, loss of consciousness, sei zures, and/or needing another person to assist with treat ment [9], This is not, however, a universally accepted def inition. In some studies children must lose consciousness in order to have severe hypoglycaemia [3,5,7,8,10]. If this definition of severe hypoglycaemia were used with the DCCT data, the frequency of severe hypoglycaemia in intensively treated adolescents was 26.7 episodes/100 pa tient-years, compared with 9.7 episodes/100 patient-years in the conventionally treated group [9], Other investiga tors may define severe hypoglycaemia as occurring when ever the blood glucose levels falls below a predetermined value, regardless of the presence or absence of symptoms.…”

Section: Problems With the Numerator Of Frequency Calculationsmentioning

confidence: 99%

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The Frequency of Severe Hypoglycaemia in Children with Insulin-Dependent Diabetes Mellitus

Clarke¹,

Gonder-Frederick²,

Cox³

1996

Horm Res

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The literature contains numerous reports of the frequency of severe hypoglycaemia in childhood insulin-dependent diabetes mellitus. Unfortunately, most of these data have been collected in such a manner as to make comparisons between them difficult. Most reports have used small, well-defined populations of children who were participants in larger, complex, clinical studies. Additional difficulties are encountered in the standardization of the definition of severe hypoglycaemia. Some studies have required that the child lose consciousness while others also included children who required assistance with treatment. Even when studies clearly define the representative nature of their patient population and include universally acceptable criteria for identifying a severe hypoglycaemic episode, the frequency of severe hypoglycaemia must be qualified. Severe hypoglycaemia is generated by a series of complex biological, psychological, and behavioural processes. Its frequency must be viewed not as a fixed value, but rather as a dynamic dependent variable.

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“…4 Intensification of insulin therapy may also be associated with an increase in frequency of severe hypoglycaemia in paediatric patients. 5 However, Nordfeldt and Ludvigsson have recently reported that near-normal HbA 1c levels may be achieved without noticeable increase in incidence of severe hypoglycaemia, defined as an episode resulting in unconsciousness. 6 Most published large studies on severe hypoglycaemia in children examine patients on conventional treatment and show an incidence of severe hypoglycaemia (coma and/or convulsion) which varies from 4.8 to 22 episodes per 100 patient-years.…”

Section: Introductionmentioning

confidence: 99%

Severe hypoglycaemia in children and adolescents during multiple-dose insulin therapy

1998

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Episodes of severe hypoglycaemia, resulting in coma and/or convulsions, were documented in an unselected, population-based group of 376 children and adolescents with Type 1 diabetes mellitus (Type 1 DM) treated at the Aurora Hospital, City of Helsinki. A prospective study in 1994-95 yielded 493 patient-years and a retrospective study in 1990-93, 904 patient-years of data. Of these patients, 77-85% received insulin in three or more daily doses. During 1990-95, 43 patients had a total of 48 severe hypoglycaemic episodes. For each episode (n = 48), one control Type 1 DM patient who had never experienced any severe hypoglycaemia, matched by age, diabetes duration and puberty, was sought from the study population. Incidence of severe hypoglycaemia was 3.1/100 patients years prospectively and 3.6/100 retrospectively. At the time of the episode, median age was 13.3 (range 2.2-21) years, and median diabetes duration 6.1 (0.5-14.6) years. Rates were similar in different age groups (< 6, 6-12.9 and > or = 13 years). A potential explanation for the hypoglycaemia was found in 79% of the episodes. Insulin dose was higher (p = 0.04) and HbA1c lower (p = 0.005) in patients with severe hypoglycaemia than in controls. In conclusion, multiple-dose insulin therapy in young patients with Type 1 DM can be associated with a low rate of severe hypoglycaemia. The majority of such episodes seem to be preventable.

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Increasing Incidence of Hypoglycemic Coma in Children With IDDM

Abstract: In this group of children, improvement of glycemic control apparently led to an increase in the incidence of severe hypoglycemia. In children with recurrent hypoglycemic coma and undetectable C-peptide levels, it may be safer to aim for somewhat less tight glycemic control.

Cited by 46 publications

References 20 publications

Presentation and progress of childhood diabetes mellitus: a prospective population-based study

Presentation and progress of childhood diabetes mellitus: a prospective population-based study

The Frequency of Severe Hypoglycaemia in Children with Insulin-Dependent Diabetes Mellitus

Severe hypoglycaemia in children and adolescents during multiple-dose insulin therapy

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