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Severe hypoglycemia in children and adolescents with IDDM: frequency and associated factors
C Limbert1, J Schwingshandl, J Haas
1Department of Pediatrics, University of Graz, Austria.
Insights
Severe hypoglycemia affects nearly half of young people with insulin-dependent diabetes mellitus (IDDM). Older age and longer diabetes duration increase the risk of these serious hypoglycemic events.
Area of Science:
- Pediatrics
- Endocrinology
- Metabolic Disorders
Background:
- Severe hypoglycemia is a frequent complication in pediatric patients with insulin-dependent diabetes mellitus (IDDM).
- Understanding the factors contributing to severe hypoglycemia is crucial for effective management and prevention strategies in this population.
Purpose of the Study:
- To assess the frequency of severe hypoglycemia in children and adolescents with IDDM.
- To identify associated factors, including age, diabetes duration, and glycemic control, that may predispose patients to severe hypoglycemic episodes.
Main Methods:
- A prospective survey of 74 children and adolescents with IDDM over a 1-year period.
- Standardized questionnaires were used to collect data on severe and mild hypoglycemic episodes, treatment, and prevention.
- Statistical analysis was performed to compare characteristics between patients with and without severe hypoglycemia.
Main Results:
- Forty-four percent of patients experienced at least one severe hypoglycemic episode (requiring assistance or causing loss of consciousness).
- The event rate was 0.77 severe episodes per patient-year.
- Patients with severe hypoglycemia were significantly older (mean age 16.3 years) and had a longer duration of diabetes (mean 8.2 years) compared to those without.
Conclusions:
- Older age and longer duration of diabetes are significant risk factors for severe hypoglycemia in youths with IDDM.
- Potential contributing factors include diminished counterregulatory responses and suboptimal diabetes treatment.
- Ongoing vigilance and targeted education are essential for managing hypoglycemia in older adolescents with long-standing diabetes.
Abstract:
Severe hypoglycemia is a very common complication in youths with insulin-dependent diabetes mellitus (IDDM). Seventy four children and adolescents were surveyed for a 1-year period to evaluate the frequency and associated factors of severe hypoglycemia. Patients or their parents completed a standardized questionnaire which inquired about severe and mild episodes, treatment, and prevention of hypoglycemia. Forty-four percent of the patients experienced at least one severe hypoglycemic episode [need for assistance (grade III), loss of consciousness with or without convulsions (grade IV)] during the survey period. The event rate was 0.77 episodes (grade III and IV) per patient-year. The group with severe hypoglycemic episodes was significantly older (mean age, 16.3 years; SD, 3.6 years versus mean age 13.7 years; SD, 4.9 years; p = 0.01) and had significantly longer duration of diabetes (mean, 8.2 years; SD, 4.3 years versus mean, 6.1 years; SD, 4.0 years; p = 0.04) than the group without severe hypoglycemic episodes. There were no significant differences in mean glycosylated hemoglobin (HbA1c), daily doses of insulin, type of insulin regimen, gender, and age at diagnosis between patients who reported severe episodes and those who did not. Mild hypoglycemia was reported by 72 patients. Fifty percent of the patients recognized potential precipitating factors. Older age and longer duration of diabetes seem to predispose the patient to severe hypoglycemia. This may be the result of a diminution of the counterregulation system including lower neuroadrenergic reaction, or the still unphysiologic treatment of diabetes. Continued vigilance and education is important in older adolescents with longer duration of diabetes.