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Endocrinol Diabetes Nutr. 2019 Oct 23. pii: S2530-0164(19)30202-2. doi: 10.1016/j.endinu.2019.07.009. [Epub ahead of print]

Hypoglycaemia unawareness in young people with type 1 diabetes transferred to an adult center.

[Article in English, Spanish]

Author information

1
Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España. Electronic address: mvidal@clinic.cat.
2
Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España.
3
Unidad de Endocrinología Pediátrica, Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España.
4
Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España; IDIBAPS, Institut d'investigacions biomèdiques August Pi i Sunyer, Barcelona, España; CIBERDEM. Centro de Investigación Biomédica en Red de Diabetes y Enfermedades metabólicas, Madrid, España.

Abstract

OBJECTIVE:

To evaluate frequency of hypoglycaemia unawareness (HU) in patients with type 1 diabetes (T1D) transferred from Paediatrics following a specific therapeutic education programme (TEP) in an adult hospital.

PATIENTS AND METHODS:

Young patients transferred from 2009-2011 were evaluated. The TEP included a coordinated transfer process, individual appointments and a group course. At baseline and at 12 months we evaluated glycated haemoglobin (HbA1c) frequency of severe (SH) hypoglycaemia/patient/year and non severe hypoglycaemia (NSH). The patients were classified into two groups and compared: hypoglycaemia awareness (HA) and HU according to the Clarke Test <3R or>3R respectively.

RESULTS:

Fifty-six patients (age 18.1±0.3 years, 46% females, HbA1c 8.0±1.2%) underwent the TEP. In the baseline evaluation 16% presented HU. The number of SH was higher in the HU Group (0.33±0.50 vs. 0.09±0.28 P<.05). The percentage of patients with>2 NSH/week was higher, albeit not significantly, in the HU group (66% vs. 34%, p=0.06). At 12 months 11% of the patients continued to present HU. The number of SH remained higher in the HU group (0.38±1.06 vs. 0.02±0.15 P=.04).

CONCLUSIONS:

The percentage of young people with T1D with HU is quite high at transfer. Although the TEP improves hypoglycaemia awareness it does not solve this important problem. Patients with HU more frequently present SH. It is necessary to identify HU in order to reduce SH which continues to be a problem in people with T1D.

KEYWORDS:

Diabetes mellitus tipo 1; Hipoglucemias desapercibidas; Hipoglucemias graves; Severe hypoglycaemia; Transfer from pediatric to adult care; Traslado desde pediatría a unidades de adultos; Type 1 diabetes mellitus; Unawareness hypoglycaemia

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