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Dysglycemia in Children with Severe Acute Malnutrition: A Systematic Review and Meta-Analysis
Elizabeth Ledger1, Philliness Prisca Harawa2,3, Allison I Daniel4,5
1Medical Research Council The Gambia at the London School of Hygiene & Tropical Medicine, Keppel Street, London, UK.
Insights
Hypoglycemia affects 9% of children with severe acute malnutrition (SAM) and significantly increases their mortality risk. Further research is needed to understand dysglycemia
Area of Science:
- Pediatric Endocrinology
- Global Health
- Nutritional Science
Background:
- Dysglycemia, including hypoglycemia and hyperglycemia, is a frequent complication in children with severe acute malnutrition (SAM).
- The prevalence and clinical impact of dysglycemia in hospitalized children with SAM remain incompletely understood.
- Understanding these metabolic disturbances is crucial for improving patient outcomes.
Purpose of the Study:
- To systematically review and quantify the prevalence of hypoglycemia and hyperglycemia in hospitalized children with SAM.
- To investigate the association between dysglycemia and clinical outcomes, particularly mortality, in this vulnerable population.
- To evaluate the certainty of the existing evidence regarding dysglycemia in SAM.
Main Methods:
- A systematic literature search was conducted using MEDLINE with terms related to children, SAM, and dysglycemia.
- Meta-analyses of proportions were performed to determine hypoglycemia prevalence and its association with mortality.
- The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of the evidence.
Main Results:
- The pooled prevalence of hypoglycemia in children with SAM was 9% (95% CI: 7%, 12%), with low certainty evidence.
- Hypoglycemia was significantly associated with increased mortality risk during hospitalization (OR: 4.29; 95% CI: 3.04, 6.05), with moderate certainty evidence.
- Hyperglycemia prevalence varied widely (2%-38%) due to inconsistent definitions, with very low certainty evidence.
Conclusions:
- Hypoglycemia is a common and serious complication in hospitalized children with SAM, linked to higher mortality.
- The evidence for hyperglycemia prevalence and its outcomes in SAM is limited and of very low certainty.
- Further research employing standardized glucose monitoring is essential to clarify the clinical significance of dysglycemia in SAM.
Abstract:
Dysglycemia is a common complication of severe acute malnutrition (SAM) in children. Its prevalence and impact on short- and long-term outcomes are not well described. This systematic review was undertaken to review the available evidence on dysglycemia (either hypo- or hyperglycemia) in hospitalized children with SAM. The 2 primary objectives of this systematic review were to understand the prevalence of hypoglycemia and hyperglycemia in children with SAM. A secondary objective was to understand the relation between dysglycemia and clinical outcomes like mortality in children with SAM. MEDLINE was searched with terms related to children, SAM, and dysglycemia. A meta-analysis of proportions was completed to determine the hypoglycemia prevalence and a standard meta-analysis was done to determine the relation between hypoglycemia and mortality. The certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. A total of 2148 articles were identified in the database search of which 16 met the inclusion criteria for the systematic review based on screening done by multiple reviewers. The overall prevalence of hypoglycemia in SAM across studies based on the meta-analysis of proportions was 9% (95% CI: 7%, 12%; I2 = 92%). Meta-analysis results showed that hypoglycemia was associated with a higher chance of mortality during hospitalization in children with SAM (OR: 4.29; 95% CI: 3.04, 6.05; I2 = 0%). According to the GRADE evaluation, the certainty of the evidence for the prevalence of hypoglycemia was low and for hyperglycemia was very low. For the relation between hypoglycemia and mortality, the certainty of the evidence was moderate. A meta-analysis was not carried out for the prevalence of hyperglycemia due to the wide range of definitions used for across studies, but the prevalence ranged from 2% to 38% in the literature. This systematic review highlights the need for further work in this area to include serial glucose measurements to understand the clinical importance of dysglycemia during hospitalization in children with SAM.
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