The Relationship Between Clinical Profiles, Glycemic Parameters, and Hypoglycemia in Pediatric Patients with Type 1
Andreea Morar-Stan1, Luminița Dobrotă1, Anișoara Răduțu2
1Faculty of Medicine, "Lucian Blaga" University of Sibiu, 550024 Sibiu, Romania.
Insights
The coefficient of variation (%CV) and mean daily glucose (MDG) predict hypoglycemia risk in children with type 1 diabetes. Maintaining %CV below 36% is crucial for minimizing hypoglycemia risk in pediatric patients.
Area of Science:
- Endocrinology
- Pediatrics
- Metabolic Disorders
Background:
- Type 1 diabetes (T1D) management in children requires careful monitoring to prevent hypoglycemia.
- Continuous Glucose Monitoring (CGM) provides valuable data for assessing glycemic control and risks.
Purpose of the Study:
- To evaluate the predictive role of clinical and CGM parameters for hypoglycemia risk in pediatric T1D patients.
- To identify key indicators for predicting mild and clinically significant hypoglycemia.
Main Methods:
- A cohort of 71 pediatric T1D patients using CGM was followed for at least 6 months.
- Analyzed parameters included age, BMI, Time in Range, Mean Daily Glucose (MDG), and Coefficient of Variation (%CV).
- Hypoglycemia was defined as time below 3.9 mmol/L (mild) and 3.0 mmol/L (significant).
Main Results:
- Lower MDG and higher %CV were significantly associated with hypoglycemia.
- %CV emerged as the dominant predictor for both hypoglycemia thresholds.
- Patients under 7 years showed the highest frequency of hypoglycemic episodes.
- Specific %CV (<36.15%) and MDG (>7.16 mmol/L) thresholds were identified for reduced hypoglycemia risk.
Conclusions:
- %CV and MDG are key predictors of hypoglycemia risk in pediatric T1D.
- A %CV below 36% is recommended to minimize hypoglycemia.
- Age is also a factor, with younger children (<7 years) being more susceptible.
Abstract:
Background/Objectives: Our objective was to assess the role of clinical and continuous glucose monitoring (CGM) parameters in predicting the risk of hypoglycemia in pediatric patients with type 1 diabetes. Methods: Pediatric patients with type 1 diabetes (n = 71) at the Oradea County Clinical Emergency Hospital, Romania, who underwent CGM during their initial visit and were followed for at least 6 months with in-clinic visits every 3 months were enrolled in this study. Age, body mass index, time in range, the mean daily glucose (MDG) concentration, and the coefficient of variation (%CV) were considered as potential predictors of the risk of hypoglycemia, which was defined as the percentage of time spent below two glycemic thresholds of 3.9 and 3.0 mmol/L, corresponding to mild and clinically significant hypoglycemia, respectively. Results: Among a total of 142 glycemic profiles, the MDG concentration was significantly lower in those with hypoglycemia compared to those without, whereas %CV was significantly higher (p < 0.0001). Regression tree models identified %CV as the dominant variable for both thresholds, whereas classification tree models identified %CV as the dominant variable for clinically significant hypoglycemia and MDG for mild hypoglycemia. In profiles with a %CV of less than 36.15% and an MDG concentration greater than 7.16 mmol/L, the mean percentage of time spent below the 3.9 mmol/L threshold was 4.8%, which is close to that recommended by the American Diabetes Association guidelines. Patients younger than 7 years presented the highest frequency for both mild and clinically significant hypoglycemic episodes. Conclusions: Our study supports %CV and the MDG concentration as key factors in predicting hypoglycemia risk. Minimizing the risk of hypoglycemia in pediatric patients requires a %CV of less than 36%.
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