Severe hypoglycemia and diabetic ketoacidosis among youth with type 1 diabetes in the T1D Exchange clinic registry

Cengiz, Eda; Xing, Dongyuan; Wong, Jenise C.; Wolfsdorf, Joseph I.; Haymond, Morey W.; Rewers, Arleta; Shanmugham, Satya; Tamborlane, William V.; Willi, Steven M.; Seiple, Diane L.; Miller, Kellee M.; DuBose, Stephanie N.; Beck, Roy W.

doi:10.1111/pedi.12030

Cited by 225 publications

(206 citation statements)

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“…Similar decreases in HbA 1c levels without concomitant increases in SH have been observed in clinical trials of new insulin analogs (18), with use of new insulin pumps (19), and in CGM trials (20). Our data also indicate that DKA remains a problem in a substantial percentage of patients (11,12). Since the risk of DKA was increased in participants with HbA 1c levels .9.0% (75 mmol/mol), poor compliance with their diabetes treatment regimens undoubtedly contributes to the increased risk of DKA.…”

Section: Discussionmentioning

confidence: 85%

“…A comprehensive set of baseline clinical, laboratory, and demographic data were obtained for each participant at registry enrollment and the core data have been updated annually. The data collected at baseline have provided a number of particularly notable findings (Supplementary Table 1), including showing that most adults and children with type 1 diabetes were not achieving HbA 1c goals set by the ADA and ISPAD (6)(7)(8); that there was a relationship between increased frequency of blood glucose testing and lower HbA 1c levels (9); that ethnic/racial and socioeconomic factors played a role in differences in metabolic control and use of insulin pumps in youth with type 1 diabetes (10); that diabetic ketoacidosis (DKA) occurred less frequently in insulin pump users than injection users (11,12); and that CGM was being used by only a small proportion of adults and children with type 1 diabetes (13).…”

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confidence: 99%

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Current State of Type 1 Diabetes Treatment in the U.S.: Updated Data From the T1D Exchange Clinic Registry

et al. 2015

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To examine the overall state of metabolic control and current use of advanced diabetes technologies in the U.S., we report recent data collected on individuals with type 1 diabetes participating in the T1D Exchange clinic registry. Data from 16,061 participants updated between 1 September 2013 and 1 December 2014 were compared with registry enrollment data collected from 1 September 2010 to 1 August 2012. Mean hemoglobin A1c (HbA1c) was assessed by year of age from <4 to >75 years. The overall average HbA1c was 8.2% (66 mmol/mol) at enrollment and 8.4% (68 mmol/mol) at the most recent update. During childhood, mean HbA1c decreased from 8.3% (67 mmol/mol) in 2–4-year-olds to 8.1% (65 mmol/mol) at 7 years of age, followed by an increase to 9.2% (77 mmol/mol) in 19-year-olds. Subsequently, mean HbA1c values decline gradually until ∼30 years of age, plateauing at 7.5–7.8% (58–62 mmol/mol) beyond age 30 until a modest drop in HbA1c below 7.5% (58 mmol/mol) in those 65 years of age. Severe hypoglycemia (SH) and diabetic ketoacidosis (DKA) remain all too common complications of treatment, especially in older (SH) and younger patients (DKA). Insulin pump use increased slightly from enrollment (58–62%), and use of continuous glucose monitoring (CGM) did not change (7%). Although the T1D Exchange registry findings are not population based and could be biased, it is clear that there remains considerable room for improving outcomes of treatment of type 1 diabetes across all age-groups. Barriers to more effective use of current treatments need to be addressed and new therapies are needed to achieve optimal metabolic control in people with type 1 diabetes.

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Section: Discussionmentioning

confidence: 85%

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confidence: 99%

Current State of Type 1 Diabetes Treatment in the U.S.: Updated Data From the T1D Exchange Clinic Registry

et al. 2015

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“…Increasingly, evidence is emerging that rates of severe hypoglycaemia may be reducing [3,11,12]. This may have resulted from improvements in therapy [13], suggesting that re-evaluation of the factors associated with severe events may be required.…”

Section: Introductionmentioning

confidence: 99%

A population-based study of risk factors for severe hypoglycaemia in a contemporary cohort of childhood-onset type 1 diabetes

et al. 2013

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Aims/hypothesis Severe hypoglycaemia is a major barrier to optimising glycaemic control. Recent changes in therapy, however, may have altered the epidemiology of severe hypoglycaemia and its associated risk factors. The aim of this study was to examine the incidence rates and risk factors associated with severe hypoglycaemia in a contemporary cohort of children and adolescents with type 1 diabetes. Methods Subjects were identified from a population-based register containing data on >99% of patients (<16 years of age) who were being treated for type 1 diabetes in Western Australia. Patients attend the clinic approximately every 3 months, where data pertaining to diabetes management, demographics and complications including hypoglycaemia are prospectively recorded. A severe hypoglycaemic event was defined as an episode of coma or convulsion associated with hypoglycaemia. Risk factors assessed included age, duration of diabetes, glycaemic control, sex, insulin therapy, socioeconomic status and calendar year.Results Clinical visit data from 1,770 patients, providing 8,214 patient-years of data between 2000 and 2011 were analysed. During follow-up, 841 episodes of severe hypoglycaemia were observed. No difference in risk of severe hypoglycaemia was observed between age groups. Good glycaemic control (HbA 1c <7% [53 mmol/mol]) compared with the cohort average (HbA 1c 8-9% [64-75 mmol/mol]) was not associated with an increased risk of severe hypoglycaemia. When compared with patients on injection regimens, subjects aged 12-18 years on pump therapy were at reduced risk of severe hypoglycaemia (incidence risk ratio 0.6; 95% CI 0.4, 0.9). Conclusions/interpretation In this population-based sample of children and adolescents with type 1 diabetes, contemporary therapy is associated with a changed pattern and incidence of severe hypoglycaemia.

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“…Diabetic ketoacidosis (DKA) accounts for 13% (2,3) to 19% (4) of disease-related mortality and occurs at a rate of 1-10/100 patient-years in children and adolescents with established diabetes remaining largely constant within the last decade (1,5,6,7). In contrast, the incidence of severe hypoglycemia has decreased during the past decade and recent reports refer to rates of 16-20/100 patient-years for severe hypoglycemia (defined as requiring assistance from another person) and 2-8/100 patient-years for hypoglycemic coma (loss of consciousness or seizures) (1,7,8,9,10,11), accounting for 4-10% (2, 3, 4, 12) of diseaserelated mortality.…”

Section: Introductionmentioning

confidence: 99%

Hospital admission for diabetic ketoacidosis or severe hypoglycemia in 31 330 young patients with type 1 diabetes

Karges

Rosenbauer

Holterhus

et al. 2015

European Journal of Endocrinology

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Objective: To investigate rates and risk factors of hospital admission for diabetic ketoacidosis (DKA) or severe hypoglycemia in young patients with established type 1 diabetes. Design: In total, 31 330 patients with type 1 diabetes (median age 12.7 years) from the Diabetes Patienten Verlaufsdokumentation (DPV) Prospective Diabetes Registry treated between 2011 and 2013 in Germany were included. Methods: Admission rates for DKA (pH !7.3 or bicarbonate !15 mmol/l) and severe hypoglycemia (requiring assistance from another person) were calculated by negative binomial regression analysis. Associations of DKA or hypoglycemia with patient and treatment characteristics were assessed by multivariable regression analysis. Results: The mean admission rate for DKA was 4.81/100 patient-years (95% CI, 4.51-5.14). The highest DKA rates were observed in patients with HbA1c R9.0% (15.83 (14.44-17.36)), age 15-20 years (6.21 (5.61-6.88)) and diabetes duration of 2-4.9 years (5.60 (5.00-6.27)). DKA rate was higher in girls than in boys (5.35 (4.88-5.86) vs 4.34 (3.95-4.77), PZ0.002), and more frequent in migrants than in non-migrants (5.65 (4.92-6.49) vs 4.57 (4.23-4.93), PZ0.008). The mean admission rate for severe hypoglycemia was 1.45/100 patient-years (1.30-1.61). Rates were higher in migrants compared to non-migrants (2.13 (1.72-2.65) vs 1.28 (1.12-1.47), P!0.001), and highest in individuals with severe hypoglycemia within the preceding year (17.69 (15.63-20.03) vs patients without preceding hypoglycemia 0.42 (0.35-0.52), P!0.001). Differences remained significant after multivariable adjustment. Conclusions: The identification of at-risk individuals for DKA (patients with high HbA1c, longer diabetes duration, adolescents, girls) and for severe hypoglycemia (patients with preceding severe hypoglycemia, migrants) may facilitate targeted diabetes counselling in order to prevent these complications.

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Severe hypoglycemia and diabetic ketoacidosis among youth with type 1 diabetes in the T1D Exchange clinic registry

Cited by 225 publications

References 18 publications

Current State of Type 1 Diabetes Treatment in the U.S.: Updated Data From the T1D Exchange Clinic Registry

Current State of Type 1 Diabetes Treatment in the U.S.: Updated Data From the T1D Exchange Clinic Registry

A population-based study of risk factors for severe hypoglycaemia in a contemporary cohort of childhood-onset type 1 diabetes

Hospital admission for diabetic ketoacidosis or severe hypoglycemia in 31 330 young patients with type 1 diabetes

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