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Hill H, Klaar P, Espes D. Real-life data of hypoglycemic events in children and adolescents with type 1 diabetes. BMJ Open Diabetes Res Care 2023; 11:e003485. [PMID: 37739421 PMCID: PMC10533671 DOI: 10.1136/bmjdrc-2023-003485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/05/2023] [Indexed: 09/24/2023] Open
Abstract
INTRODUCTION Hypoglycemia composes an always present risk in the treatment of type 1 diabetes (T1D) and can be a fatal complication. Many studies on hypoglycemic events are based on self-reported data or focused on the aggregated time below range. We have processed continuous glucose monitoring (CGM) data in children and adolescents with T1D in order to examine all occurring hypoglycemic events. RESEARCH DESIGN AND METHODS CGM data (mean 168±3 days) from 214 children and adolescents with T1D were analyzed using computer-based algorithms. Patients were divided into three groups based on estimated HbA1c (eHbA1c): (1) ≤48 mmol/mol (n=58); (2) 49-64 mmol/mol (n=113); (3) ≥65 mmol/mol (n=43). The groups were compared concerning descriptive data and CGM metrics with emphasis on the frequency of hypoglycemic events. RESULTS Only one self-reported event of severe hypoglycemia was registered, while 54 390 hypoglycemic events (<3.9 mmol/L (<70 mg/dL)) were identified from CGM data out of which 11 740 were serious (<3.0 mmol/L (<54 mg/dL)). On average there were 1.5±0.1 hypoglycemic events per 24 hours out of which 1.2±0.1 were mild (3.0-3.9 mmol/L) and 0.3±0.02 serious. Group 1 had a higher frequency of both total and mild hypoglycemic events compared with both groups 2 and 3. However, the frequency of serious hypoglycemic events was similar in all groups. A negative correlation was observed for eHbA1c and total daily and mild hypoglycemic events (r=-0.57 and r=-0.66, respectively, p<0.0001), whereas for serious hypoglycemic events there was only a borderline significance (r=-0.13, p=0.05). CONCLUSIONS This study shows that hypoglycemic events are a frequent phenomenon in children and adolescents with T1D, occurring regardless of overall metabolic control. Although patients with an HbA1c ≤48 mmol/mol had a higher frequency of mild hypoglycemic events there was no increase in serious hypoglycemic events.
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Affiliation(s)
- Henrik Hill
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Daniel Espes
- Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Science for Life Laboratory, Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
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Addala A, Zaharieva DP, Gu AJ, Prahalad P, Scheinker D, Buckingham B, Hood KK, Maahs DM. Clinically Serious Hypoglycemia Is Rare and Not Associated With Time-in-range in Youth With New-onset Type 1 Diabetes. J Clin Endocrinol Metab 2021; 106:3239-3247. [PMID: 34265059 PMCID: PMC8530719 DOI: 10.1210/clinem/dgab522] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Indexed: 02/06/2023]
Abstract
CONTEXT Early initiation of continuous glucose monitoring (CGM) is advocated for youth with type 1 diabetes (T1D). Data to guide CGM use on time-in-range (TIR), hypoglycemia, and the role of partial clinical remission (PCR) are limited. OBJECTIVE Our aims were to assess whether 1) an association between increased TIR and hypoglycemia exists, and 2) how time in hypoglycemia varies by PCR status. METHODS We analyzed 80 youth who were started on CGM shortly after T1D diagnosis and were followed for up to 1-year post diagnosis. TIR and hypoglycemia rates were determined by CGM data and retrospectively analyzed. PCR was defined as (visit glycated hemoglobin A1c) + (4*units/kg/day) less than 9. RESULTS Youth were started on CGM 8.0 (interquartile range, 6.0-13.0) days post diagnosis. Time spent at less than 70 mg/dL remained low despite changes in TIR (highest TIR 74.6 ± 16.7%, 2.4 ± 2.4% hypoglycemia at 1 month post diagnosis; lowest TIR 61.3 ± 20.3%, 2.1 ± 2.7% hypoglycemia at 12 months post diagnosis). No events of severe hypoglycemia occurred. Hypoglycemia was rare and there was minimal difference for PCR vs non-PCR youth (54-70 mg/dL: 1.8% vs 1.2%, P = .04; < 54mg/dL: 0.3% vs 0.3%, P = .55). Approximately 50% of the time spent in hypoglycemia was in the 65 to 70 mg/dL range. CONCLUSION As TIR gradually decreased over 12 months post diagnosis, hypoglycemia was limited with no episodes of severe hypoglycemia. Hypoglycemia rates did not vary in a clinically meaningful manner by PCR status. With CGM being started earlier, consideration needs to be given to modifying CGM hypoglycemia education, including alarm settings. These data support a trial in the year post diagnosis to determine alarm thresholds for youth who wear CGM.
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Affiliation(s)
- Ananta Addala
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, California, USA
- Correspondence: Ananta Addala, DO, MPH, Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA 94305, USA.
| | - Dessi P Zaharieva
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, California, USA
| | - Angela J Gu
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, California, USA
- Department of Management Science and Engineering, Stanford University, Stanford, California, USA
| | - Priya Prahalad
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford, California, USA
| | - David Scheinker
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, California, USA
- Department of Management Science and Engineering, Stanford University, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford, California, USA
| | - Bruce Buckingham
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford, California, USA
| | - Korey K Hood
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford, California, USA
| | - David M Maahs
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford, California, USA
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Chalew S, Delamater AM, Washington S, Bhat J, Franz D, Gomez R, Felipe D, Tieh P, Finger L. Can Innovative Technologies Overcome HbA1c Disparity for African-American Youth with Type 1 Diabetes? J Diabetes Sci Technol 2021; 15:1069-1075. [PMID: 34137288 PMCID: PMC8442203 DOI: 10.1177/19322968211021386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Achieving normal or near-normal glycemic control as reflected by HbA1c levels in patients with type 1 diabetes (T1D) is important for preventing the development and progression of chronic complications. Despite delineation and dissemination of HbA1c management targets and advances in insulin pharmacology, insulin delivery systems, and glucose monitoring, the majority of children with T1D do not achieve HbA1c goals. In particular, African Americans are more likely not to reach HbA1c goals and have persistently higher HbA1c than Non-Hispanic Whites. Availability of pumps and other technology has not eliminated the disparity in HbA1c. Multiple factors play a role in the persisting racial disparity in HbA1c outcome. The carefully designed application and deployment of new technology to help the patient/family and facilitate the supportive role of the diabetes management team may be able to overcome racial disparity in glycemic outcome and improve patient quality of life.
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Affiliation(s)
- Stuart Chalew
- Department of Pediatrics,
Division of Pediatric Endocrinology and Diabetes, School of Medicine,
Louisiana State University Health Sciences Center, Children’s Hospital of
New Orleans, New Orleans, LA, USA
- Stuart Chalew, MD, Department of
Pediatrics, Endocrinology and Diabetes, School of Medicine, Louisiana
State University Health Sciences Center, Children’s Hospital of New
Orleans, 200 Henry Clay Avenue, New Orleans, LA 70118, USA.
| | - Alan M. Delamater
- Department of Pediatrics,
University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sonja Washington
- Endocrinology and Diabetes, The
Children’s Hospital of New Orleans, New Orleans, LA, USA
| | - Jayalakshmi Bhat
- Department of Pediatrics,
Division of Pediatric Endocrinology and Diabetes, School of Medicine,
Louisiana State University Health Sciences Center, Children’s Hospital of
New Orleans, New Orleans, LA, USA
| | - Diane Franz
- Department of Psychology, The
Children’s Hospital of New Orleans, New Orleans, LA, USA
| | - Ricardo Gomez
- Department of Pediatrics,
Division of Pediatric Endocrinology and Diabetes, School of Medicine,
Louisiana State University Health Sciences Center, Children’s Hospital of
New Orleans, New Orleans, LA, USA
| | - Dania Felipe
- Department of Pediatrics,
Division of Pediatric Endocrinology and Diabetes, School of Medicine,
Louisiana State University Health Sciences Center, Children’s Hospital of
New Orleans, New Orleans, LA, USA
| | - Peter Tieh
- Department of Pediatrics,
Division of Pediatric Endocrinology and Diabetes, School of Medicine,
Louisiana State University Health Sciences Center, Children’s Hospital of
New Orleans, New Orleans, LA, USA
| | - Laurie Finger
- Endocrinology and Diabetes, The
Children’s Hospital of New Orleans, New Orleans, LA, USA
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Fureman AL, Lilja M, Lind T, Särnblad S, Bladh M, Samuelsson U. Comparing continuous subcutaneous insulin infusion and multiple daily injections in children with Type 1 diabetes in Sweden from 2011 to 2016-A longitudinal study from the Swedish National Quality Register (SWEDIABKIDS). Pediatr Diabetes 2021; 22:766-775. [PMID: 33929074 DOI: 10.1111/pedi.13217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/18/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This study aimed to compare metabolic control measured as hemoglobin A1c (HbA1c), the risk of severe hypoglycemia, and body composition measured as body mass index standard deviation scores (BMI-SDS) in a nationwide sample of children and adolescents with Type 1 diabetes with continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI), respectively. RESEARCH DESIGN AND METHODS Longitudinal data from 2011 to 2016 were extracted from the Swedish National Quality Register (SWEDIABKIDS) with both cross-sectional (6 years) and longitudinal (4 years) comparisons. Main end points were changes in HbA1c, BMI-SDS, and incidence of severe hypoglycemia. RESULTS Data were available from 35,624 patient-years (54% boys). In general, HbA1c decreased approximately 0.5% (2-5 mmol/mol) from 2011 to 2016 (ptrend < 0.001) and the use of CSII increased in both sexes and all age groups. Mean HbA1c was 0.1% (0.7-1.5 mmol/mol) lower in the CSII treated group. Teenagers, especially girls, using CSII tended to have higher BMI-SDS. There was no difference in the number of hypoglycemias between CSII and MDI over the years 2011-2016. CONCLUSIONS There was a small decrease in HbA1c with CSII treatment but of little clinical relevance. Overall, mean HbA1c decreased in both sexes and all age groups without increasing the episodes of severe hypoglycemia, indicating that other factors than insulin method contributed to a better metabolic control.
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Affiliation(s)
- Anna-Lena Fureman
- Department of Clinical Sciences, Pediatrics, Östersund Hospital, Umeå University, Umeå, Sweden
| | - Mikael Lilja
- Department of Public Health and Clinical Medicine, Unit of Research, Education and Development, Östersund Hospital, Umeå University, Umeå, Sweden
| | - Torbjörn Lind
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Stefan Särnblad
- Department of Pediatrics, Örebro University, Hospital and School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Marie Bladh
- Department of Obstetrics and Gynecology and Biomedical and Clinical Sciences, Linköping University Hospital, Linköping University, Linköping, Sweden
| | - Ulf Samuelsson
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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