ISPAD Clinical Practice Consensus Guidelines 2018: Assessment and management of hypoglycemia in children and adolescents with diabetes

Abraham, Mary; Jones, Timothy W.; Naranjo, Diana; Karges, Beate; Oduwole, Abiola; Tauschmann, Martin; Maahs, David M.

doi:10.1111/pedi.12698

Cited by 192 publications

(258 citation statements)

References 194 publications

(359 reference statements)

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“…This definition of SH in pediatric patients is in line with that for SH used in adults . Severe hypoglycemic coma (classified as a subgroup of SH) is defined as an event associated with a seizure or loss of consciousness …”

Section: Introductionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

“…Hypoglycemia (often defined in clinical practice as a blood glucose level ≤3.9 mmol/L) is the most frequent acute complication of type 1 diabetes . At blood glucose concentrations of 3.3‐3.9 mmol/L, individuals are at increased risk of severe hypoglycemia (SH), which is typically defined on the basis of symptoms rather than blood glucose levels. The most recent International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines, based on recommendations by the International Hypoglycaemia Study Group, define SH in pediatric patients as an event with severe cognitive impairment (including coma and convulsions) requiring external assistance of another person to actively administer carbohydrates, glucagon, or take other corrective actions .…”

Section: Introductionmentioning

confidence: 99%

“…Fear of hypoglycemia is common and debilitating in children and adolescents with type 1 diabetes and can adversely affect parents' and caregivers' quality of life (QoL) . In the modern era of diabetes management, patients with type 1 diabetes, their families and caregivers require reassurance that a combination of good glycemic control and low overall risk of SH is now far more frequently attained in routine clinical practice than previously . Nonetheless, it is crucial to remember that protracted SH may lead to coma, seizures, and in some cases death, especially when such hypoglycemia occurs during sleep …”

Section: Introductionmentioning

confidence: 99%

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Incidence of severe hypoglycemia and possible associated factors in pediatric patients with type 1 diabetes mellitus in the real‐life, post‐DCCT setting: a systematic review

Cherubini¹,

Rabbone

Lombardo

et al. 2019

Pediatr Diabetes

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Background/Objective In 1993, the Diabetes Control and Complications Trial (DCCT) found that intensive antihyperglycemic therapy was effective in the primary and secondary prevention of microvascular complications in patients with type 1 diabetes (T1D) but was associated with a 3‐fold greater rate of severe hypoglycemia (SH) than conventional therapy. The aim of this analysis was to determine whether, in the real‐world setting, the incidence of SH in pediatric patients with T1D has changed since 1993. Methods A systematic literature search of PubMed for prospective or retrospective observational studies (≥250 participants) on SH epidemiology or related topics in pediatric patients with T1D, published between October 1993 and June 2016, identified 35 articles (involving >55 000 participants). SH incidence data were analyzed in approximate 5‐year blocks: 1993‐2000, 2001‐2005, 2006‐2010, and 2011‐2016. Information on factors that might influence the incidence of SH was also collected. Results A trend for a marked reduction in the incidence of SH in the post‐DCCT setting (from 62.0 per 100 patient‐years to 1.21‐30 per 100 patient‐years) was apparent. Factors that could have influenced this temporal trend in SH incidence included the increased use of new types of, and methods of administering, insulin, in particular rapid‐acting insulin analogs and continuous subcutaneous insulin infusion. Conclusions SH in pediatric patients with T1D has declined in incidence since the DCCT but remains a common problem. The optimal use of new insulin therapies/regimens/technologies, improved education, and dedicated specialized management teams are needed to help reduce the risk of SH in this population.

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Section: Introductionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Incidence of severe hypoglycemia and possible associated factors in pediatric patients with type 1 diabetes mellitus in the real‐life, post‐DCCT setting: a systematic review

Cherubini¹,

Rabbone

Lombardo

et al. 2019

Pediatr Diabetes

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show abstract

“…Participants with HbA1C less than 7.5% and with no attacks of symptomatic hypoglycemia throughout the 3‐month follow‐up period were considered to have optimum glycemic control. Symptomatic hypoglycemia was defined as blood glucose level less than 70 mg/dL with any symptoms of hypoglycemia whether associated with altered sensorium or not …”

Section: Methodsmentioning

confidence: 99%

Prospective evaluation of insulin‐to‐carbohydrate ratio in children and adolescents with type 1 diabetes using multiple daily injection therapy

Hegab

2019

Pediatr Diabetes

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Aim Assessment of insulin‐to‐carbohydrate ratio (ICR) in children and adolescents with type 1 diabetes mellitus (T1DM) using multiple daily injection (MDI) therapy. Methods This prospective observational study was conducted over a 2‐year period at Sohag University Hospital, Egypt. Children and adolescents aged 4 to 17 years, diagnosed with T1DM for at least 1 year, with fasting serum C‐peptide levels <0.24 ng/dL and whose parents accepted to shift their management to flexible MDI using carbohydrate counting, were included. Participants were initially hospitalized for estimation of ICR and insulin doses, then followed‐up monthly for further adjustments. Insulin doses, ICR, and glycemic control parameters were assessed after 3 months. Results The study included 201 participants, 110 (54.7%) of them were males. The median age was 9.5 years (interquartile range: 7‐12.5 years). Bolus insulin requirements estimated by the 500 rule were significantly lower than the actual doses used by the study participants for all meals (P < .001). Bolus insulin requirement for morning meal was significantly higher compared to other meals (P < .001). Linear regression analyses between ICR for different meals and the reciprocal of total daily dose (TDD) in 96 participants with optimum glycemic control revealed that ICR could be calculated as 301 to 309/TDD for morning meal (R2 = 0.97, P < .001), 317 to 331/TDD for afternoon meal (R2 = 0.96, P < .001), and 362 to 376/TDD for evening meal (R2 = 0.98, P < .001). Conclusions Bolus insulin requirements showed diurnal variation. Using 301 to 309/TDD, 317 to 331/TDD, and 362 to 376/TDD formulas would be more appropriate than the 500 rule for initial estimation of ICR for morning, afternoon, and evening meals, respectively.

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Trends in Out-of-Pocket Cost of Glucagon, 2010-2020

2022

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Cost-sharing should not serve as a major barrier to accessing glucagon for MA and commercially insured patients. Further work should assess other barriers to guideline-concordant glucagon uptake among patients at risk of severe hypoglycemia. Such barriers may include awareness among patients and primary care, emergency, and diabetes clinicians of the availability of this potentially life-saving treatment. In addition, future studies may examine the association of novel glucagon formulations, which had similar OOPCs to those of unmixed glucagon and may be easier to administer, with uptake in the coming years.

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ISPAD Clinical Practice Consensus Guidelines 2018: Assessment and management of hypoglycemia in children and adolescents with diabetes

Cited by 192 publications

References 194 publications

Incidence of severe hypoglycemia and possible associated factors in pediatric patients with type 1 diabetes mellitus in the real‐life, post‐DCCT setting: a systematic review

Incidence of severe hypoglycemia and possible associated factors in pediatric patients with type 1 diabetes mellitus in the real‐life, post‐DCCT setting: a systematic review

Prospective evaluation of insulin‐to‐carbohydrate ratio in children and adolescents with type 1 diabetes using multiple daily injection therapy

Trends in Out-of-Pocket Cost of Glucagon, 2010-2020

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