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Symptomatic hypoglycaemia in 411 type 1 diabetic patients
S Pramming1, B Thorsteinsson, I Bendtson
1Steno Memorial Hospital, Gentofte, Denmark.
Insights
Symptomatic hypoglycemia, a common concern for Type 1 diabetes patients, occurred more frequently on weekdays and in the morning. Symptoms varied and lessened with longer diabetes duration.
Area of Science:
- Endocrinology
- Metabolic Disorders
- Diabetes Management
Background:
- Symptomatic hypoglycemia is a significant complication in Type 1 diabetes management.
- Understanding the frequency and patterns of hypoglycemia is crucial for patient care and treatment optimization.
Purpose of the Study:
- To prospectively assess the frequency of symptomatic hypoglycemic episodes in conventionally treated Type 1 diabetic outpatients.
- To investigate factors influencing hypoglycemia frequency, including time of day, day of week, and patient characteristics.
Main Methods:
- A prospective study involving 411 Type 1 diabetic outpatients.
- Data collection included home questionnaires and a 1-week prospective diary recording of hypoglycemic episodes.
- Analysis correlated hypoglycemia frequency with insulin dosage, injection frequency, insulin type, HbA1c, age, and diabetes duration.
Main Results:
- Prospective frequencies were 1.8 mild and 0.027 severe episodes per patient-week.
- Hypoglycemia was more common on working days (1.8:1) and in the morning (4.5:2.2:1.4:1 ratio for morning:afternoon:evening:night).
- Symptoms were non-specific and diminished with longer diabetes duration; 36% experienced hypoglycemic coma. Weak correlations found with insulin dose, injections, unmodified insulin percentage, and HbA1c.
Conclusions:
- Symptomatic hypoglycemia is a frequent occurrence in Type 1 diabetes, with distinct temporal patterns.
- Hypoglycemia management requires attention to daily routines and time of day.
- While weakly correlated with certain treatment parameters, further research may be needed to fully elucidate contributing factors.
Abstract:
The frequency of symptomatic hypoglycaemic episodes was studied in 411 randomly selected conventionally treated Type 1 diabetic out-patients. Between two consecutive visits to the out-patient clinic each patient filled in a questionnaire at home. The number of hypoglycaemic episodes was then recorded prospectively in a diary for 1 week. From the questionnaires, the (retrospective) frequencies of mild and severe symptomatic hypoglycaemia were 1.6 and 0.029 episodes patient-1 week-1. From the diaries, the (prospective) frequencies of mild and severe hypoglycaemic episodes were 1.8 and 0.027 patient-1 week-1. Symptomatic hypoglycaemia was more frequent on working days than during weekends (1.8:1) and more frequent in the morning than during the afternoon, evening, and night (4.5:2.2:1.4:1). The symptoms of hypoglycaemia were non-specific, heterogeneous, and weakened with increasing duration of diabetes. During their diabetic life, 36% of the patients had experienced hypoglycaemic coma. The frequency of hypoglycaemia was positively, but only weakly, correlated with insulin dose, number of injections, percentage unmodified insulin of the total dose, and HbA1c (mild hypoglycaemia only). The frequency was also negatively, but weakly, correlated with age and HbA1c (episodes with coma only), but not correlated with sex, duration of diabetes, or patients' ratings of worries about mild and severe hypoglycaemia.