Format

Send to

Choose Destination
Pediatr Diabetes. 2019 Jun 8. doi: 10.1111/pedi.12876. [Epub ahead of print]

Incidence of severe hypoglycemia and possible associated factors in pediatric patients with type 1 diabetes mellitus in the real-life, post-DCCT setting: a systematic review.

Author information

1
"G. Salesi" Hospital, Department of Women's and Children's Health, Azienda Ospedaliero-Universitaria, Ancona, Italy.
2
Department of Paediatrics, University of Turin, Italy.
3
Department of Human Pathology, University of Messina, Italy.
4
Diabetes Business Unit, Eli Lilly, Sesto Fiorentino, Italy.
5
CORESEARCH, Centre for Outcomes Research and Clinical Epidemiology, Pescara, Italy.

Abstract

BACKGROUND:

In 1993, the Diabetes Control and Complications Trial (DCCT) found that intensive antihyperglycemic therapy was effective in the primary and secondary prevention of microvascular complications in patients with type 1 diabetes mellitus (T1DM) but was associated with a 3-fold greater rate of severe hypoglycemia (SH) than conventional therapy.

AIM:

To determine whether, in the real-world setting, the incidence of SH in pediatric patients with T1DM has changed since 1993.

METHODS:

A systematic literature search of PubMed for prospective or retrospective observational studies (≥250 participants) on SH epidemiology or related topics in pediatric patients with T1DM, published between October 1993 and June 2016, identified 35 articles (involving >55,000 participants). SH incidence data were analyzed in approximate 5-year blocks: 1993-2000, 2001-2005, 2006-2010, and 2011-2016. Information on factors that might influence the incidence of SH was also collected.

RESULTS:

A trend for a marked reduction in the incidence of SH in the post-DCCT setting (from 62.0 per 100 patient-years to 1.21-30 per 100 patient-years) was apparent. Factors that could have influenced this temporal trend in SH incidence included the increased use of new types of, and methods of administering, insulin, in particular rapid-acting insulin analogs and continuous subcutaneous insulin infusion.

CONCLUSIONS:

SH in pediatric patients with T1DM has declined in incidence since the DCCT but remains a common problem. The optimal use of new insulin therapies/regimens/technologies, improved education, and dedicated specialized management teams are needed to help reduce the risk of SH in this population. This article is protected by copyright. All rights reserved.

KEYWORDS:

Diabetes mellitus, type 1; hypoglycemia; pediatrics; review, systematic

PMID:
31177592
DOI:
10.1111/pedi.12876

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center