[Episodes of severe hypoglycemia--increasing problem in type 1 diabetes]

A cross-sectional survey of severe hypoglycaemia was performed in type 1 diabetes mellitus patients in 1984 and repeated in 1998 at the diabetes out-patient clinic of a Swedish university hospital. The study revealed that the prevalence of severe hypoglycaemia had increased by more than 50 per cent over 14 years, in spite of more frequent use of multiple insulin injection therapy and daily self monitoring of blood glucose. A multiple logistic regression analysis of risk factors for severe hypoglycaemia explained less than 10% of the variance, implicating only unawareness of hypoglycaemia and HbA1c. It is concluded that long duration type 1 diabetes mellitus patients are increasingly vulnerable with respect to severe hypoglycaemia and that this should be taken into account when individual treatment goals are being proposed to patients. Novel short-acting and long-acting analogs of insulin as well as insulin pumps may prove useful to minimize the risk of severe hypoglycaemic episodes. It is argued that the ability of currently marketed glucose monitoring systems to sensitively and specifically detect hypoglycaemia is limited.