Prevalence of impaired awareness of hypoglycemia and identification of predictive symptoms in children and adolescents with type 1 diabetes

Graveling, Alex; Noyes, Kathryn; Allerhand, Michael H; Wright, Rohana J.; Bath, Louise; Deary, Ian J.; Frier, Brian M.

doi:10.1111/pedi.12077

Cited by 25 publications

(37 citation statements)

References 31 publications

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“…Previous studies have demonstrated a link between lower HbA1c and SH; however, this relationship is weaker in subsequent studies . This is also reflected in this report with a relationship of lower HbA1c with IAH in the 2002 cohort but not in the 2015 cohort and in other recent studies …”

Section: Discussionsupporting

confidence: 50%

“…21,22 This is also reflected in this report with a relationship of lower HbA1c with IAH in the 2002 cohort but not in the 2015 cohort and in other recent studies. 10,23,24 It is worth noting that although rates of SH have reduced significantly, the magnitude of reduction is not paralleled by a similar reduction in IAH prevalence. We have previously addressed the risk factors for SH in our cohort between 2000 and 2011.…”

Section: Discussionmentioning

confidence: 99%

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Reduced prevalence of impaired awareness of hypoglycemia in a population-based clinic sample of youth with type 1 diabetes

et al. 2016

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Section: Discussionsupporting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Reduced prevalence of impaired awareness of hypoglycemia in a population-based clinic sample of youth with type 1 diabetes

et al. 2016

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“…As efforts to achieve optimal glucose control increase in order to prevent the chronic complications of diabetes, the risk of hypoglycemia increases. Recurrent antecedent hypoglycemia induces sympathoadrenal responses and unawareness of hypoglycemia (6)(7)(8)(9)(10). This is known as impaired hypoglycemia awareness (IHA) and can be defined as the inability to perceive the onset of hypoglycemia.…”

Section: Introductionmentioning

confidence: 99%

“…The perception of adrenergic symptoms are reduced or disappear completely (6,7). It has been reported that careful glucose monitoring, individualized blood glucose targets and structured education programs are important in preventing and managing IHA (6)(7)(8)(9)(10). Real time continuous glucose monitoring systems reduce IHA in children, adolescents and adults with type 1 diabetes (6,10).…”

Section: Introductionmentioning

confidence: 99%

Effect of Education on Impaired Hypoglycemia Awareness and Glycemic Variablity in Children and Adolescents with Type 1 Diabetes Mellitus

Demir¹,

Özen²,

Çetin³

et al. 2019

Jcrpe

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What is already known in this topic? Impaired hypoglycemia awareness and glycemic variability are important problems causing acute and chronic complications in children and adolescents with type 1 diabetes. What this study adds?Professional continuous glucose measurement system is a valuable tool to diagnose impaired hypoglycemia awareness in type 1 diabetic children and adolescents. IHA, GV and time in range can be improved by educationbased intervention. AbstractObjective: The aim of this study was to determine the prevalence of impaired hypoglycemia awareness (IHA) in children and adolescents with type 1 diabetes mellitus with professional continuous glucose monitoring system and to show the effect of structured education on glycemic variability (GV) in children and adolescents with IHA. Methods: Fourty type 1 diabetic children and adolescents with a diabetes duration of at least 5 years were eligible for inclusion in this prospective, quantitative study. All subjects were asked about their history of being aware of the symptoms of hypoglycemia with a questionnaire. Professional continuous glucose monitoring (CGM) were placed to all of the patients for six days. The frequency of IHA detected by CGM and logbook reports were analyzed. Patients with IHA diagnosed by CGM underwent a structured training program. After 3 months, CGM was re-applied to patients with IHA. Results: The study was completed by 37 diabetic children and adolescents. After the initial CGM nine patients (24.3%) were determined to have had episodes of IHA. Area under the curve (AUC) for hypoglycemia and number of low excursions were; 1.81±0.95 and 8.33±3.60 for the IHA group at the beginning of the study. AUC for hypoglycemia was 0.43±0.47 after three months of structured education the IHA patients (p=0.01). Coefficient of variation (CV) which shows primary glycemic variability decreased significantly although unstable at the end of education in IHA patients (p=0.03). Conclusion: CGM is a valuable tool to diagnose impaired hypoglycemia awareness. IHA, GV and time in range can be improved by education-based intervention.

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“…Impaired awareness may affect up to approximately one-third of pediatric patients with diabetes. 7,8 …”

mentioning

confidence: 99%

Hypoglycemia-Associated EEG Changes in Prepubertal Children With Type 1 Diabetes

Hansen

Foli-Andersen

Fredheim

et al. 2016

J Diabetes Sci Technol

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Background:The purpose of this study was to explore the possible difference in the electroencephalogram (EEG) pattern between euglycemia and hypoglycemia in children with type 1 diabetes (T1D) during daytime and during sleep. The aim is to develop a hypoglycemia alarm based on continuous EEG measurement and real-time signal processing.Method:Eight T1D patients aged 6-12 years were included. A hyperinsulinemic hypoglycemic clamp was performed to induce hypoglycemia both during daytime and during sleep. Continuous EEG monitoring was performed. For each patient, quantitative EEG (qEEG) measures were calculated. A within-patient analysis was conducted comparing hypoglycemia versus euglycemia changes in the qEEG. The nonparametric Wilcoxon signed rank test was performed. A real-time analyzing algorithm developed for adults was applied.Results:The qEEG showed significant differences in specific bands comparing hypoglycemia to euglycemia both during daytime and during sleep. In daytime the EEG-based algorithm identified hypoglycemia in all children on average at a blood glucose (BG) level of 2.5 ± 0.5 mmol/l and 18.4 (ranging from 0 to 55) minutes prior to blood glucose nadir. During sleep the nighttime algorithm did not perform.Conclusions:We found significant differences in the qEEG in euglycemia and hypoglycemia both during daytime and during sleep. The algorithm developed for adults detected hypoglycemia in all children during daytime. The algorithm had too many false alarms during the night because it was more sensitive to deep sleep EEG patterns than hypoglycemia-related EEG changes. An algorithm for nighttime EEG is needed for accurate detection of nocturnal hypoglycemic episodes in children. This study indicates that a hypoglycemia alarm may be developed using real-time continuous EEG monitoring.

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Prevalence of impaired awareness of hypoglycemia and identification of predictive symptoms in children and adolescents with type 1 diabetes

Abstract: IAH affects a substantial minority of children and impending hypoglycemia may be heralded by behavioral symptoms. The 'Clarke' method was more effective at identifying those at increased risk and could be used as a screening tool.

Cited by 25 publications

References 31 publications

Reduced prevalence of impaired awareness of hypoglycemia in a population-based clinic sample of youth with type 1 diabetes

Reduced prevalence of impaired awareness of hypoglycemia in a population-based clinic sample of youth with type 1 diabetes

Effect of Education on Impaired Hypoglycemia Awareness and Glycemic Variablity in Children and Adolescents with Type 1 Diabetes Mellitus

Hypoglycemia-Associated EEG Changes in Prepubertal Children With Type 1 Diabetes

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