Unrecognised hypoglycaemia in children and adolescents with type 1 diabetes using the continuous glucose monitoring system: Prevalence and contributors

Wiltshire, Esko; Newton, Kirsty; McTavish, Lindsay

doi:10.1111/j.1440-1754.2006.00973.x

Cited by 32 publications

(21 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…On 23% of hypoglycemic nights, sensor glucose levels ≤60 mg/dl were present for almost 2 h and the duration of hypoglycemia was longer in those aged <25 years. It seems unlikely that the observed incidence of nocturnal hypoglycemia is an overestimate because prior outpatient studies using CGM have reported even higher rates (8,9,11–13), as have inpatient studies using blood glucose measurements (10,14). Although sensor inaccuracy could produce misclassification of some nights as to whether hypoglycemia occurred, an inpatient accuracy study conducted by the Diabetes Research in Children Network using the FreeStyle Navigator showed that the false-positive and false-negative rates for nocturnal hypoglycemia were approximately the same (21).…”

Section: Discussionmentioning

confidence: 95%

“…Studies that used retrospective and real-time continuous glucose monitoring (CGM) systems to assess glycemic control of type 1 diabetes indicate that severe hypoglycemic events are only the tip of the iceberg regarding the risk of nocturnal hypoglycemia, because many more events are unrecognized and asymptomatic (8–14). Detection of such events is important, however, because recurrent episodes of mild hypoglycemia have been shown to contribute to the development of defective counterregulatory hormone responses to subsequent reductions in blood glucose, thus setting the stage for clinically important hypoglycemic events.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Prolonged Nocturnal Hypoglycemia Is Common During 12 Months of Continuous Glucose Monitoring in Children and Adults With Type 1 Diabetes

2010

Diabetes Care

156

View full text Add to dashboard Cite

OBJECTIVETo characterize the amount of nocturnal hypoglycemia and evaluate factors associated with nocturnal hypoglycemia assessed with continuous glucose monitoring (CGM) in adults and children with type 1 diabetes who participated in the Juvenile Diabetes Research Foundation CGM randomized clinical trial.RESEARCH DESIGN AND METHODSThe analysis included 36,467 nights with ≥4 h of CGM glucose readings between 12 midnight and 6:00 a.m. from 176 subjects assigned to the CGM group of the trial. The percentage of nights in which hypoglycemia occurred (two consecutive CGM readings ≤60 mg/dl in 20 min) was computed for each subject. Associations with baseline characteristics and clinical factors were evaluated using a multivariate regression model.RESULTSHypoglycemic events occurred during 8.5% of nights, with the median percentage of nights with hypoglycemia per subject being 7.4% (interquartile range 3.7–12.1%). The duration of hypoglycemia was ≥2 h on 23% of nights with hypoglycemia. In a multivariate model, a higher incidence of nocturnal hypoglycemia was associated with 1) lower baseline A1C levels (P < 0.001) and 2) the occurrence of hypoglycemia on one or more nights during baseline blinded CGM (P < 0.001). The hypoglycemia frequency was not associated with age or with insulin modality (pump versus multiple daily injections).CONCLUSIONSNocturnal hypoglycemia is frequent and often prolonged in adults and children with type 1 diabetes. Patients with low A1C levels are at an increased risk for its occurrence. One week of blinded CGM can identify patients who are at greater risk for nocturnal hypoglycemia.

show abstract

Section: Discussionmentioning

confidence: 95%

mentioning

confidence: 99%

Prolonged Nocturnal Hypoglycemia Is Common During 12 Months of Continuous Glucose Monitoring in Children and Adults With Type 1 Diabetes

2010

Diabetes Care

156

View full text Add to dashboard Cite

show abstract

“…Alternatively, it could also be that certain severe conditions, which may last for many hours, including cerebral malaria, may associate clinical but difficult to detect hypoglycaemic episodes in the context of an already altered clinical status. Previous studies using the CGMs have confirmed overnight unrecognized hypoglycaemia is common among children with type 1 diabetes [39] but very little is known on the impact of recognized and unrecognized hypoglycaemia in non-diabetic children. On the other hand, fasting is considered a risk factor because it leads to glycogen depletion, which can result in decreased glucose production and hypoglycaemia [40].…”

Section: Discussionmentioning

confidence: 99%

Continuous determination of blood glucose in children admitted with malaria in a rural hospital in Mozambique

Madrid

Sitoe

Varo

et al. 2017

Malar J

View full text Add to dashboard Cite

BackgroundHypoglycaemia is a frequent complication among admitted children, particularly in malaria-endemic areas. This study aimed to estimate the occurrence of hypoglycaemia not only upon admission but throughout the first 72 h of hospitalization in children admitted with malaria.MethodsA simple pilot study to continuously monitor glycaemia in children aged 0–10 years, admitted with malaria in a rural hospital was conducted in Southern Mozambique by inserting continuous glucose monitors (CGMs) in subcutaneous tissue of the abdominal area, producing glycaemia readings every 5 min.ResultsGlucose was continuously monitored during a mean of 48 h, in 74 children. Continuous measurements of blood glucose were available for 72/74 children (97.3%). Sixty-five of them were admitted with density-specific malaria diagnosis criteria (17 severe, 48 uncomplicated). Five children (7.7%) had hypoglycaemia (<54 mg/dL) on admission as detected by routine capillary determination. Analysing the data collected by the CGMs, hypoglycaemia episodes (<54 mg/dL) were detected in 10/65 (15.4%) of the children, of which 7 (10.8%) could be classified as severe (≤45 mg/dL). No risk factors were independently associated with the presence of at least one episode of hypoglycaemia (<54 mg/dL) during hospitalization. Only one death occurred among a normoglycaemic child. All episodes of hypoglycaemia detected by CGMs were subclinical episodes or not perceived by caregivers or clinical staff.ConclusionsHypoglycaemia beyond admission in children with malaria appears to be much more frequent than what had been previously described. The clinical relevance of these episodes of hypoglycaemia in the medium or long term remains to be determined.

show abstract

“…Although this study confirms that CSII improved glycemic instability without reducing HbA1c, the quarterly application of CGM is not sufficient to improve overall control [44]. However, others have reported its usefulness in the management of individual patients, particularly adolescents experiencing difficulties with adherence to diabetes management and in detecting unrecognized hypoglycemia [45]. CGM can also be used to compare the effectiveness of various therapeutic strategies in research settings [46].…”

Section: The Old Technology – Holter-type Retrospective Sensorsmentioning

confidence: 89%

Real-Time Glucose Sensors in Children and Adolescents with Type-1 Diabetes

2008

View full text Add to dashboard Cite

The increased availability of continuous glucose sensors is likely to have a significant impact on pediatric diabetes therapy and education in the future. While a recent meta-analysis of retrospective first-generation Holter-type sensors was not able to show advantages compared to self-monitoring of blood glucose levels, this review focuses on current real-time sensors. Our own experience with 23 children aged 10 (3–15) years with sensor-augmented pump therapy showed high ratings for overall satisfaction and ease of use of the system (5.8 on a 7 point Likert scale). The results of our ongoing international pediatric ONSET trial will show the impact of this technology on learning to live with diabetes by having the biofeedback of glucose excursions from the onset of diabetes. Families previously relying on self-monitoring of blood glucose need to understand the difference between estimating the absolute blood glucose value (point accuracy) and the change in blood glucose (rate accuracy), and how to take into consideration the inherent interstitial time lag. Selection of patients capable and motivated to use continuous sensors accompanied with proper age-appropriate education remain key factors for the long-term success of these new technological advances in diabetes therapy as long as closed loop systems are not available.

show abstract

Unrecognised hypoglycaemia in children and adolescents with type 1 diabetes using the continuous glucose monitoring system: Prevalence and contributors

Cited by 32 publications

References 35 publications

Prolonged Nocturnal Hypoglycemia Is Common During 12 Months of Continuous Glucose Monitoring in Children and Adults With Type 1 Diabetes

Prolonged Nocturnal Hypoglycemia Is Common During 12 Months of Continuous Glucose Monitoring in Children and Adults With Type 1 Diabetes

Continuous determination of blood glucose in children admitted with malaria in a rural hospital in Mozambique

Real-Time Glucose Sensors in Children and Adolescents with Type-1 Diabetes

Contact Info

Product

Resources

About