Prevalence and Associations of Impaired Awareness of Hypoglycemia in Pediatric Type 1 Diabetes
abstract
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Access this abstract now Full Text Available for ClinicalKey SubscribersAIMS
To determine the prevalence and associations of impaired awareness of hypoglycemia (IAH) in pediatric type 1 diabetes.
METHODS
Nationwide, population-based cross-sectional study with 51 % participation. Participants (n = 1329; 53 % males) aged 2–19 years (median 13.3) with type 1 diabetes ≥ 6 months (median 4.6 years) self-assessed hypoglycemia awareness with a validated questionnaire (‘Clarke’). Parents responded for children aged < 9 years (n = 235). We estimated associations between IAH and clinical data in the Norwegian Childhood Diabetes Registry.
RESULTS
The overall prevalence of IAH was 22 %, but gradually decreased from 53 % in preschoolers to 12 % in adolescents aged ≥ 16 years. IAH was associated (adjusted OR; 95 %CI) with episodes of severe hypoglycemia (6.0; 3.04, 11.8) and diabetic ketoacidosis (3.45; 1.37, 8.68) the preceding year, increased fear of hypoglycemia (highest quartile vs. lowest: 2.27; 1.51, 3.40), female sex (1.41; 1.05, 1.90), and HbA1c ≥ 8.5 % (69 mmol/mol) vs. 7.5–8.4 % (58–68 mmol/mol) (1.48; 1.01, 2.18), but not with disease duration, use of insulin pump or continuous glucose monitoring, or HbA1c < 7.5 % (58 mmol/mol).
CONCLUSIONS
IAH is prevalent in pediatric diabetes and more likely reported in young children. IAH is associated with severe hypoglycemia and fear of hypoglycemia, but good metabolic control seems achievable without increased risk of IAH.
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Prevalence and associations of impaired awareness of hypoglycemia in a pediatric type 1 diabetes population - The Norwegian Childhood Diabetes Registry
Diabetes Res. Clin. Pract. 2024 Jan 13;[EPub Ahead of Print], H Hatle, T Skrivarhaug, MR Bjørgaas, BO Åsvold, TB RøFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
In this study from Norway, hypoglycemia unawareness in children and teens with type 1 diabetes was explored. The term describes a condition in which the usual adrenergic warning signs of hypoglycemia do not occur, resulting in the rapid development of mental status changes, which can culminate in unconsciousness and seizures. It is common in insulin-treated patients, particularly when tightly controlled. The investigators found that more than 1 out of every 5 individuals had hypoglycemia unawareness, with a greater proportion observed among those younger than 4 years (although, we wonder if this merely reflects difficulty for these youngsters to express the sensations that hypoglycemia induces). Other risk factors included prior history of severe hypoglycemia, prior history of diabetic ketoacidosis, and female sex.