Temporal Trends of Blood Glucose in Children with Cerebral Malaria

Abstract

Hypoglycemia, defined as a blood glucose < 2.2 mmol/L, is associated with death in pediatric cerebral malaria (CM). The optimal duration of glucose monitoring in CM is unknown. We collected data from 1,674 hospitalized Malawian children with CM to evaluate the association between hypoglycemia and death or neurologic disability in survivors. We assessed the optimal duration of routine periodic measurements of blood glucose. Children with hypoglycemia at admission had a 2.87-fold higher odds (95% CI: 1.35–6.09) of death and, if they survived, a 3.21-fold greater odds (95% CI: 1.51–6.86) of sequelae at hospital discharge. If hypoglycemia was detected at 6 hours but not at admission, there was a 7.27-fold higher odds of death (95% CI: 1.85–8.56). The presence of newly developed hypoglycemia after admission was not independently associated with neurological sequelae in CM survivors. Among all new episodes of blood sugar below a treatment threshold of 3.0 mmol/L, 94.7% occurred within 24 hours of admission. In those with blood sugar below 3.0 mmol/L in the first 24 hours, low blood sugar persisted or recurred for up to 42 hours. Hypoglycemia at admission or 6 hours afterward is strongly associated with mortality in CM. Children with CM should have 24 hours of post-admission blood glucose measurements. If a blood glucose less than the treatment threshold of 3.0 mmol/L is not detected, routine assessments may cease. Children who have blood sugar values below the treatment threshold detected within the first 24 hours should continue to have periodic glucose measurements for 48 hours post-admission.

Opportunities for Improving Outcomes in Severe Malaria: the Role of Blood Glucose Monitoring

“…In this issue of the The American Journal of Tropical Medicine & Hygiene , Chastang et al. 7 present a retrospective study of a cohort of Malawian children with CM. They evaluated the strength of association between low glucose levels at admission/post-admission and adverse outcomes in children with CM, and also the utility of repeated glucose determinations.…”

“…The Chastang et al. 7 study provides valuable data that could help clinicians in resource-limited settings improve CM management with more efficient use of available resources. Further research may consolidate these findings and eventually influence international recommendations, but there is a need for more clinical studies to better understand the pathophysiology of CM and optimize its management.…”