medwireNews: Poor control of blood glucose is the strongest predictor of hospital admission for diabetic ketoacidosis (DKA) and severe hypoglycaemia among children with Type 1 diabetes, a study shows.

“Strikingly, ketoacidosis rates nearly exponentially rose with increasing HbA1c [glycated haemoglobin]”, say Beate Karges (RWTH Aachen University, Germany) and study co-authors.

The DKA rate rose from less than one case per 100 person–years among patients with HbA1c levels below 6.0% to around 16 per 100 person–years among those with levels of 9.0% or higher. After accounting for confounders, this equated to a more than 20-fold risk increase.

And the risk for DKA roughly doubled in children when their diabetes had endured for more than a year.

“A plausible explanation for this finding is the complete loss of beta cell function after that time, while residual insulin secretion in individuals with short diabetes duration may partially protect from DKA”, write the researchers in the European Journal of Clinical Endocrinology.

During an average follow-up of 0.77 years, there were 1159 hospital admissions for DKA and 345 for severe hypoglycaemia among 30,814 children and adolescents in the German DPV Prospective Diabetes Registry.

Poor metabolic control also influenced children’s risk of being hospitalised with severe hypoglycaemia, with the risk increased 43.5-fold among those admitted for hypoglycaemia during the previous year.

“These findings emphasize the need of detailed evaluation of every severe hypoglycemic episode, and more importantly, specific diabetes counselling in order to prevent hypoglycemia with ongoing diabetes treatment”, say Karges et al.

The risk of admission for severe hypoglycaemia was also significantly increased among patients whose family were migrants, and among adolescents aged 15 to 20 years, while girls had a significantly increased risk of being admitted for DKA.

The researchers therefore suggest that these groups should also be targeted for educational efforts.

“It has been shown that structured diabetes education may reduce the incidence of DKA and severe hypoglycemia by more than 50% and targeted diabetes counselling in high risk individuals with type 1 diabetes might particularly reduce and prevent these acute complications”, they note.

By Eleanor McDermid, Senior medwireNews Reporter

Eur J Endocrinol 2015; Advance online publication

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