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

Abraham, Mary; Gallego, Patricia; Brownlee, Wade M.; Smith, Geoff; Davis, Elizabeth A.; Jones, Timothy W.

doi:10.1111/pedi.12460

Cited by 21 publications

(25 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A recent study comparing FGM and CGM showed that FGM is relatively inefficient to decrease hypoglycemia in type 1 diabetic adults with impaired awareness of hypoglycemia (IAH). 20 As IAH is also prevalent in pediatric populations, 21 we cannot exclude that a high prevalence of IAH in our cohort biased our findings toward less efficacy on reducing hypoglycemia.…”

Section: Discussionmentioning

confidence: 91%

Flash Glucose Monitoring Accepted in Daily Life of Children and Adolescents with Type 1 Diabetes and Reduction of Severe Hypoglycemia in Real-Life Use

Messaaoui

Tenoutasse

Crenier

2019

Diabetes Technology & Therapeutics

View full text Add to dashboard Cite

Background: Flash glucose monitoring (FGM) is covered by the Belgian public health insurance for type 1 diabetes since 2016. The objective of this study was to describe the use of FGM and diabetes outcomes in type 1 diabetic children and adolescents 1 year after reimbursement. Methods: All patients had the choice to convert to FGM or to continue with self-monitoring of blood glucose (SMBG). Clinical data were collected at baseline, at the next visit, and after 12 months; glucose profiles at next visit and after 12 months. Regression analyses were performed to identify predictors of FGM acceptance and changes in metabolic control. Results: A total of 334 subjects were included, of whom 278 (83.2%) switched to FGM. They were younger (13.6 vs. 15.2 years; P = 0.012) and performed more SMBG testing at baseline than patients who did not switch (4.3 vs. 4.1 tests daily; P = 0.008). At the end of follow-up, the rate of severe hypoglycemia decreased by 53% in the group of FGM users (P = 0.012) while it remained stable in SMBG users. Median glycated hemoglobin did not change significantly in both groups. Among subjects who switched to FGM, 15.8% reverted to SMBG after a median use of 5.3 months. Adverse events, diabetes duration, and FGM utilization were independent predictors of the risk for reverting. FGM-related adverse events were associated with a fivefold increased risk to revert to SMBG (hazard ratio = 5.12; P < 0.0001). Conclusions: FGM is relatively well accepted and decreases the risk of severe hypoglycemic events in our pediatric population. FGM is more often discontinued in patients experiencing adverse events and with longer diabetes duration.

show abstract

Section: Discussionmentioning

confidence: 91%

Flash Glucose Monitoring Accepted in Daily Life of Children and Adolescents with Type 1 Diabetes and Reduction of Severe Hypoglycemia in Real-Life Use

Messaaoui

Tenoutasse

Crenier

2019

Diabetes Technology & Therapeutics

View full text Add to dashboard Cite

show abstract

“…Earlier studies of children and adolescents have similarly shown a significant proportion of youth to have IAH with a prevalence of 19% to 37% . However, it is reassuring to note a change in prevalence over time (33% in 2002 vs 21% in 2015) in the same population‐based cohort . Although IAH has reduced, it still remains a concern in a substantial minority of adolescents.…”

Section: Hypoglycemia Awarenessmentioning

confidence: 90%

“…10,100,101 However, it is reassuring to note a change in prevalence over time (33% in 2002 vs 21% in 2015) in the same population-based cohort. 102 Although IAH has reduced, it still remains a concern in a substantial minority of adolescents.…”

Section: Hypoglycemia Awarenessmentioning

confidence: 99%

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

et al. 2018

Self Cite

View full text Add to dashboard Cite

“…Обследование двух групп детей старше 12 лет с СД1 в одном клиническом центре в Австралии в 2002 и 2015 гг. (413 и 444 ребенка соответственно) выявило НРГ в 33% и 21% случаев [13].…”

Section: распространенностьunclassified

Impaired hypoglycemia awareness in diabetes: epidemiology, mechanisms and therapeutic approaches

Климонтов

Валерьевич²

2019

Diabetes mellitus

View full text Add to dashboard Cite

Impaired awareness of hypoglycemia (IAH) is a frequent complication of insulin therapy. Up to half insulin-treated individuals with type 1 and type 2 diabetes report the problems with hypoglycemia awareness, and 1525% of patients have a permanent IAH. A recurrent hypoglycemia is a cornerstone in IAH formation. The repeated episodes of hypoglycemia impair neurohumoral response to hypoglycemia, reduce its symptoms and induce inadequate brain adaptation to low glucose levels. In this regard, the IAH phenomenon can be considered as an example of "metabolic memory" in diabetes. The IAH is associated with episodes of severe hypoglycemia, fear of hypoglycemia and cognitive dysfunction. These associates can be combined into IAH syndrome. Development of IAH becomes a serious barrier in diabetes management. A growing body of evidence indicates that IAH is a reversible condition. If the syndrome is present, the hypoglycemia avoidance should be primary goal of the treatment. Structured training under specialized programs with psychological support is the most reasonable therapeutic approach to IAH amending. Technological approaches, including continuous subcutaneous insulin infusion, real-time continuous glucose monitoring, closed-loop insulin delivery systems ("artificial pancreas"), and islet transplantation also showed efficacy in hypoglycemia awareness improvement in some clinical studies. The diabetes management in patients with IAH is time-consuming and expensive. Therefore, step-by-step approach, from insulin personalization and therapeutic training to advanced medical technologies, should be recommended for these patients.

show abstract

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

Abstract: Although IAH has reduced, IAH is still prevalent in a substantial minority of adolescents and continues to be associated with an increased risk of SH.

Cited by 21 publications

References 27 publications

Flash Glucose Monitoring Accepted in Daily Life of Children and Adolescents with Type 1 Diabetes and Reduction of Severe Hypoglycemia in Real-Life Use

Flash Glucose Monitoring Accepted in Daily Life of Children and Adolescents with Type 1 Diabetes and Reduction of Severe Hypoglycemia in Real-Life Use

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

Impaired hypoglycemia awareness in diabetes: epidemiology, mechanisms and therapeutic approaches

Contact Info

Product

Resources

About