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Published on: June 11, 2012
Effective treatment of hypoglycemia in children with type 1 diabetes: a randomized controlled clinical trial
Lindsay McTavish1, Esko Wiltshire
1Department of Diabetes and Endocrinology, Capital and Coast District Health Board, Wellington, New Zealand.
Insights
Jellybeans were less effective for treating hypoglycemia in children with type 1 diabetes compared to glucose tablets, orange juice, or sugar mints. Other treatments normalized blood glucose within 15 minutes.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Diabetes Management
Background:
- Hypoglycemia is a common complication in children with type 1 diabetes.
- Effective and rapid oral treatments are crucial for managing hypoglycemia during activities like diabetes camp.
- Previous comparisons of oral hypoglycemia treatments in pediatric populations are limited.
Purpose of the Study:
- To compare the efficacy of four different oral carbohydrate sources for treating hypoglycemia in children with type 1 diabetes.
- To evaluate treatments using a standardized weight-based protocol during a structured camp environment.
- To determine the most effective treatment for rapid blood glucose normalization.
Main Methods:
- A randomized controlled trial was conducted during a diabetes camp involving 39 children (aged 1-12 years).
- Four treatments (glucose tablets, jellybeans, orange juice, sugar mints) were administered at a dose of 0.3 g carbohydrate/kg body weight.
- Blood glucose levels were measured at 0, 2, 5, 10, and 15 minutes post-treatment, with symptom recording.
Main Results:
- A total of 191 hypoglycemia episodes were analyzed.
- Jellybeans demonstrated the slowest and lowest blood glucose response compared to glucose tablets, orange juice, and sugar mints.
- Glucose tablets, orange juice, and sugar mints showed similar efficacy in normalizing blood glucose.
- Repeat treatment was trended to be more frequent with jellybeans (p=0.058).
Conclusions:
- Jellybeans are a less effective oral treatment for hypoglycemia in children with type 1 diabetes.
- Glucose tablets, orange juice, and sugar mints (Mentos dragees®) are similarly effective treatments.
- A 0.3 g/kg carbohydrate dose effectively resolved hypoglycemia in most children within 15 minutes, excluding jellybeans.
Objective:
To determine the most effective of four oral treatments for hypoglycemia in children with type 1 diabetes using a weight-based protocol during diabetes camp.
Methods:
During diabetes camp treatment of hypoglycemia was randomized to one of the four treatments, randomly assigned for each episode using a sealed envelope: glucose tablets, jellybeans, orange juice, and sugar mints (Mentos dragees®). An equivalent carbohydrate dose was calculated for each patient for each treatment (0.3 g carbohydrate/kg) and provided to camp leaders. Glucose was measured at 0, 2, 5, 10, and 15 min and symptoms recorded.
Results:
A total of 191 episodes of hypoglycemia were recorded in 39 children (1-12 episodes per child), with 2 episodes excluded because of protocol violations. Fifty-two episodes were treated with glucose tablets, 45 with jellybeans, 44 with juice, and 48 with sugar mints. Change in glucose at 10 (p = 0.034) and 15 min (p = 0.005) and glucose at 15 min (p = 0.026) were significantly different between treatment groups - jellybeans produced the lowest and slowest response. Glucose tablets did not differ significantly from juice or Mentos dragees. There was a trend for repeat treatment to be required more often with a single treatment 'dose' of jellybeans (p = 0.058). Symptoms occurred in 112 episodes, with a median time to symptom resolution of 12 min (interquartile range (IQR) 8-15 min).
Conclusions:
Jellybeans are less effective treatment for hypoglycemia than the other three treatments. Glucose tablets, Mentos dragees® and orange juice are of similar efficacy. Treatment with 0.3 g/kg of carbohydrate (excluding jellybeans) effectively resolved hypoglycemia in most children, with 15 min often required to normalize blood glucose.
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