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Pediatr Diabetes. 2018 May;19(3):493-500. doi: 10.1111/pedi.12610. Epub 2017 Dec 8.

Risk of recurrent severe hypoglycemia remains associated with a past history of severe hypoglycemia up to 4 years: Results from a large prospective contemporary pediatric cohort of the DPV initiative.

Author information

1
Department of Pediatrics, University of Calgary, Calgary, Canada.
2
Department of Pediatric Diabetes and Endocrinology, Alberta Children's Hospital, Calgary, Canada.
3
Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.
4
German Center for Diabetes Research (DZD), Munich, Germany.
5
Division of Endocrinology and Diabetes, Medical Faculty, German Center for Diabetes Research (DZD), RWTH Aachen University, Aachen, Germany.
6
German Diabetes Center, Institute for Biometrics and Epidemiology, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany.
7
Diabetes Centre for Children and Adolescents, Children's and Youth Hospital "AUF DER BULT", Hannover, Germany.
8
Department of Children and Adolescent Medicine, Rems-Murr-Clinics, Winnenden, Germany.
9
Center for Paediatrics, Medical Clinic Leverkusen, Leverkusen, Germany.
10
Department for Children and Adolescent Medicine, Hospital Barmherzige Schwestern Linz, Linz, Austria.
11
Diabetes Center for Children and Adolescent, DRK Clinics Berlin Westend, Berlin, Germany.
12
Department for Children and Adolescent Medicine, Helios Vogtland Clinic Plauen, Plauen, Germany.
13
Department of Pediatric Endocrinology and Diabetes, Charité Berlin, Berlin, Germany.
14
Centre Hospitalier de Luxembourg, Clinique Pediatrie, Luxembourg, Luxembourg.

Abstract

OBJECTIVES:

In a contemporary cohort of youth with type 1 diabetes, we examined the interval between episodes of severe hypoglycemia (SH) as a risk factor for recurrent SH or hypoglycemic coma (HC).

METHODS:

This was a large longitudinal observational study. Using the DPV Diabetes Prospective follow-up data, we analyzed frequency and timing of recurrent SH (defined as requiring assistance from another person) and HC (loss of consciousness or seizures) in 14 177 youths with type 1 diabetes aged <20 years and at least 5 years of follow-up.

RESULTS:

Among 14 177 patients with type 1 diabetes, 72% (90%) had no, 14% (6.8%) had 1 and 14% (3.2%) >1 SH (HC). SH or HC in the last year of observation was highest with SH in the previous year (odds ratio [OR] 4.7 [CI 4.0-5.5]/4.6 [CI 3.6-6.0]), but remained elevated even 4 years after an episode (OR 2.0 [CI 1.6-2.7]/2.2 [CI 1.5-3.1]). The proportion of patients who experienced SH or HC during the last year of observation was highest with SH/HC recorded during the previous year (23% for SH and 13% for HC) and lowest in those with no event (4.6% for SH and 2% for HC) in the initial 4 years of observation.

CONCLUSIONS:

Even 4 years after an episode of SH/HC, risk for SH/HC remains higher compared to children who never experienced SH/HC. Clinicians should continue to regularly track hypoglycemia history at every visit, adjust diabetes education and therapy in order to avoid recurrences.

KEYWORDS:

childhood diabetes; pediatric diabetes; severe hypoglycemia; type 1 diabetes

PMID:
29218766
DOI:
10.1111/pedi.12610
[Indexed for MEDLINE]

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