Nocturnal hypoglycemia in children and adolescents with insulin-dependent diabetes mellitus: prevalence and risk factors

J Pediatr. 1997 Jul;131(1 Pt 1):27-33. doi: 10.1016/s0022-3476(97)70121-5.

Abstract

Objectives: To evaluate the prevalence and risk factors of nocturnal hypoglycemia (NH) in children and adolescents with insulin-dependent diabetes mellitus.

Study design: A total of 150 patients, 87% of whom were receiving conventional therapy, were admitted to the hospital for one night. Blood glucose (BG) levels were measured hourly from 10 PM to 8 AM.

Results: The prevalence of NH was 47%; NH was asymptomatic in 49% of the cases. Risk factors were as follows: at least two episodes of severe hypoglycemia from onset of insulin-dependent diabetes mellitus (p = 0.0004), insulin dosage > 0.85 IU/kg per day (p = 0.02), more than 5% of BG measurements < or = 3.3 mmol/L during the last month of monitoring (p = 0.04). The risk decreased significantly with age (p = 0.0001). Both high predictive values and significant relative risk were found for BG thresholds < or = 5.2 mmol/L at dinner time (p < 0.0001) and < or = 6.7 mmol/L at 7 AM (p < 0.0001). When BG values at 10 PM were used, prediction of NH was weak.

Conclusions: Nocturnal hypoglycemia occurred frequently in children and adolescents with insulin-dependent diabetes mellitus. Our study found risk factors that will help pediatricians to identify those children with a high risk of NH. Especially in these patients, counseling based on the BG values before dinner and early in the morning is indicated to reduce the prevalence of NH.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Age Factors
  • Blood Glucose / analysis
  • C-Peptide / blood
  • C-Peptide / urine
  • Child
  • Child, Preschool
  • Circadian Rhythm*
  • Cohort Studies
  • Counseling
  • Diabetes Mellitus, Type 1 / complications*
  • Diabetes Mellitus, Type 1 / drug therapy
  • Eating
  • Female
  • Forecasting
  • Glycated Hemoglobin A / analysis
  • Humans
  • Hypoglycemia / blood
  • Hypoglycemia / etiology*
  • Hypoglycemia / prevention & control
  • Insulin / administration & dosage
  • Male
  • Predictive Value of Tests
  • Prevalence
  • Puberty
  • Risk Factors
  • Time Factors

Substances

  • Blood Glucose
  • C-Peptide
  • Glycated Hemoglobin A
  • Insulin