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Diabetes Res Clin Pract. 2019 Jan;147:87-92. doi: 10.1016/j.diabres.2018.11.011. Epub 2018 Nov 24.

Hypoglycemia in type 1A diabetes can develop before insulin therapy: A retrospective cohort study.

Author information

1
Department of Pediatrics, Hokkaido University School of Medicine, Sapporo, Hokkaido 060-8638, Japan.
2
Division of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center, Tokyo 183-8561, Japan.
3
Department of Pediatrics, Hokkaido University School of Medicine, Sapporo, Hokkaido 060-8638, Japan. Electronic address: akieda@med.hokudai.ac.jp.
4
Division of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center, Tokyo 183-8561, Japan. Electronic address: yhaset@gmail.com.

Abstract

AIMS:

There are as yet no cohort studies of hypoglycemia in type 1 diabetes before starting insulin therapy. Our aim was to determine the frequency and clinical features of hypoglycemia in patients with type 1A diabetes prior to commencing insulin therapy.

METHODS:

Eighty-seven patients with type 1A diabetes were enrolled, and a retrospective chart review of the patients was conducted.

RESULTS:

Hypoglycemia before insulin therapy occurred in six of 87 patients (6.9%). The HbA1c levels at the diagnosis of type 1A diabetes in the hypoglycemia group were lower than in the non-hypoglycemia group (median: 7.3% (56 mmol/mol) vs. 11.9% (106 mmol/mol), p < 0.0001). Similarly, the 24-hour urinary C-peptide (UCPR) levels of the former group were higher than those of the latter group (16.5 μg/day/m2 vs. 7.0 μg/day/m2, p = 0.0075). Hypoglycemic episodes occurred mostly in the postprandial period and gradually disappeared with a decrease in insulin secretion.

CONCLUSIONS:

We demonstrated that some patients with type 1A diabetes experience hypoglycemic episodes before insulin therapy. Patients with early-stage type 1A diabetes with relatively low HbA1c or high UCPR have a risk of hypoglycemia. These findings may impact when and how insulin is introduced in the treatment of early-stage type 1A diabetes.

KEYWORDS:

Early-stage; Insulin; Postprandial hypoglycemia; Retrospective study; Type 1 diabetes

PMID:
30481577
DOI:
10.1016/j.diabres.2018.11.011
[Indexed for MEDLINE]

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