Severe hypoglycaemia risk remains high years after previous episode in children with diabetes

By Eleanor McDermid
Pediatr Diabetes 2017; Advance online publication
02 January 2018

medwireNews: The risk of having a repeat episode of severe hypoglycaemia is elevated for at least 4 years after a previous episode in children with type 1 diabetes, although the risk is highest during the first year, researchers report.

During the first year after an episode of severe hypoglycaemia (requiring another person’s assistance), the likelihood of patients having another episode was increased 4.7-fold. The excess risk reduced after this, but remained twofold higher even at 4 years after the initial episode.

“Therefore, clinicians should continue to regularly track history of [severe hypoglycaemia] at every visit and, educate patients and families and whenever possible, adjust therapy in order to avoid recurrences”, write the researchers in Pediatric Diabetes.

There was a similar pattern for hypoglycaemic coma, which was associated with a ninefold increased risk of further episodes during the first year, falling to around fourfold by year 4.

At least one episode of severe hypoglycaemia occurred in 28% of the 14,177 patients in the cohort (median age 16.6 years), with half having repeated episodes, and 10% had hypoglycaemic coma with nearly a third of these patients having more than one event.

Severe hypoglycaemia therefore “remains a frequent concern” in contemporary patients, say Danièle Pacaud (University of Calgary, Alberta, Canada) and co-researchers. The patients were identified in the German and Austrian DPV database, and had at least 5 years of follow-up between 2006 and 2016.

Of note, the mode of insulin delivery appeared to affect rates of severe hypoglycaemia, with these being lowest among insulin pump users, at 13.4 episodes per 100 patient–years, compared with 16.4 and 18.2 per 100 patient–years among patients using multiple daily injections or a combined approach, respectively.

The researchers suggest that increased uptake of glucose monitoring and insulin delivery systems in the future could lead to a decline of severe hypoglycaemia among children with type 1 diabetes.

Patients with a migration background (at least one parent born outside of Germany or Austria) were more likely than other patients to have hypoglycaemic coma, but not severe hypoglycaemia. No other variables were associated with hypoglycaemia risk.

Pacaud and team stress that recurrent severe hypoglycaemia impacts children’s cognitive performance and quality of life, and increases their fear of hypoglycaemia.

“However, experience from the past 25 years has shown that improved metabolic control can be achieved with a decreased frequency of [severe hypoglycaemia] likely through new insulin analogs, diabetes technologies, education, support to families and quality improvement initiatives such as the DPV”, they say.

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