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Nocturnal hypoglycaemia in IDDM patients younger than 18 years
M J López1, M Oyarzabal, R Barrio
1Paediatric Endocrinology Hospital Clinico Universitario of Valencia and Valladolid, Spain.
Insights
Nocturnal hypoglycemia affects 12-14% of Spanish children with diabetes nightly. Younger children and those with lower HbA1c levels face higher risks, with pre-breakfast glucose levels being a key indicator.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Diabetes Management
Background:
- Nocturnal hypoglycemia is a significant concern in pediatric diabetes management.
- Understanding its prevalence and predictors is crucial for preventing adverse events.
Purpose of the Study:
- To determine the prevalence of nocturnal hypoglycemia in Spanish children and adolescents with diabetes.
- To identify factors associated with nocturnal hypoglycemia in this population.
Main Methods:
- Multicenter study involving 117 diabetic children and adolescents (aged 2-18 years, diabetes duration > 1 year).
- Nightly home blood glucose monitoring (3 measurements/night for 9 nights).
- Analysis of risk factors including age, HbA1c, and pre-breakfast glucose levels.
Main Results:
- A hypoglycemic event occurred in 12-14% of children per night.
- Children younger than 7 years had a higher risk (p < 0.05).
- Lower mean HbA1c levels were associated with nocturnal hypoglycemia (p < 0.0001).
- Low or very low pre-breakfast blood glucose concentrations increased the risk (p < 0.001).
- 89% of events occurred without detectable preceding symptoms.
Conclusions:
- The prevalence of nocturnal hypoglycemia in Spanish children is lower than previously reported, potentially due to lifestyle factors.
- Younger age and lower glycemic control (HbA1c) are significant risk factors.
- Pre-breakfast glucose monitoring may help identify children at risk for nocturnal hypoglycemia.
Abstract:
The present multicentre study was undertaken to assess the prevalence of nocturnal hypoglycaemia and its determining factors in 117 diabetic children and adolescents, aged 2-18 years and diabetes duration > 1 year in Spain. Each child made 3 measurements of blood glucose (BG) at home at night (between 0000 h and 0600 h) on nine separate nights. A hypoglycaemic event occurred in 12-14% of children in any one night. This is lower than rates for nocturnal hypoglycaemia reported in literature, perhaps because of relatively late mealtimes and different meal content, in Spanish children. Children aged < 7 years were at higher risk of nocturnal hypoglycaemia than older children (p < 0.05). Mean HbA1c from the year before the study and mean HbA1c measured during the closest time to the study were significantly lower in those with nocturnal hypoglycaemia (p < 0.0001). Blood glucose concentrations 2 h before hypoglycaemia did not predict nocturnal hypoglycaemia. The occurrence of low or very low blood glucose concentrations before breakfast was related to a higher risk for nocturnal hypoglycaemia (chi 2 22.97; p < 0.001). No previous symptoms were detectable in 89% of cases.