Contemporary rates of severe hypoglycaemia in youth with type 1 diabetes: variability by insulin regimen

Diabet Med. 2012 Jul;29(7):926-32. doi: 10.1111/j.1464-5491.2012.03646.x.

Abstract

Aims: To determine incidence rates of severe hypoglycaemia and compare incidence rates by insulin regimen in a diverse sample of youth with Type 1 diabetes from two sites.

Methods: In this observational study, 255 youth (51% female) aged 9-15 years receiving varied insulin regimens provided data prospectively for a median of 1.2 years. Reported episodes of severe hypoglycaemia, defined as episodes requiring help from another person for oral treatment or episodes resulting in seizure/coma, and current insulin regimens were collected systematically. Incidence rates were calculated and compared according to insulin regimen in bivariate and multivariate analyses.

Results: At first encounter, participants had a median age of 12.2 years (range 9.0-15.0), median diabetes duration of 4.4 years (range 1.0-13.0) and mean HbA(1c) of 67 ± 12 mmol/mol (8.3 ± 1.1%). The incidence rate was 37.6/100 patient-years for all severe hypoglycaemia and 9.6/100 patient-years for seizure/coma. The incidence rate for severe hypoglycaemia was 31.8/100 patient-years on continuous subcutaneous insulin infusion (pump therapy), 34.4/100 patient-years on basal-bolus injections and 46.1/100 patient-years on NPH (NPH vs. pump therapy: P = 0.04). The incidence rate for seizure/coma was 4.5/100 patient-years on pump therapy, 11.1/100 patient-years on basal-bolus injections and 14.4/100 patients-years on NPH (NPH vs. pump therapy: P = 0.004). In the multivariate analysis, the rate of seizure/coma was significantly higher for those on NPH vs. pump therapy (rate ratio 2.9, P = 0.03).

Conclusions: Rates of severe hypoglycaemia in youth with Type 1 diabetes remain high. Pump therapy was associated with lower rates of all severe hypoglycaemia and seizure/coma in comparison with NPH.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Blood Glucose / metabolism*
  • Blood Glucose Self-Monitoring
  • Child
  • Cognition Disorders / blood
  • Cognition Disorders / epidemiology*
  • Cognition Disorders / etiology*
  • Coma / epidemiology
  • Coma / etiology
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / complications
  • Diabetes Mellitus, Type 1 / epidemiology*
  • Drug Administration Schedule
  • Female
  • Humans
  • Hypoglycemia / blood
  • Hypoglycemia / complications
  • Hypoglycemia / epidemiology*
  • Hypoglycemic Agents / therapeutic use*
  • Incidence
  • Insulin / therapeutic use*
  • Insulin, Long-Acting / therapeutic use
  • Male
  • Multivariate Analysis
  • Prognosis
  • Prospective Studies
  • Seizures / epidemiology
  • Seizures / etiology
  • Treatment Outcome

Substances

  • Blood Glucose
  • Hypoglycemic Agents
  • Insulin
  • Insulin, Long-Acting