Impact of improved glycaemic control on rates of hypoglycaemia in insulin dependent diabetes mellitus
Department of Diabetes and Endocrinology, Princess
Margaret Hospital for Children, Perth, Western Australia
Correspondence to: Dr E A Davis, 36th and Hamilton Walk, Diabetes Research Center, 501 Stremmler Hall, Philadelphia, PA 19104-6015, USA.
Accepted 12
August 1997
Increased emphasis on strict glycaemic control of insulin
dependent diabetes mellitus (IDDM) in young patients may be expected to
cause increases in rates of significant hypoglycaemia. To evaluate whether this is the case for a large population based sample of IDDM
children and adolescents rates of severe (coma, convulsion) and
moderate (requiring assistance for treatment) hypoglycaemia were
studied prospectively over a four year period.
A total of 709 patients were studied yielding 2027 patient
years of data (mean (SD) age: 12.3 (4.4); range 0-18 years, duration IDDM: 4.9 (3.8) years). Details of hypoglycaemia were recorded at
clinic visits every three months when glycated haemoglobin (HbA1c) was also measured.
Overall the incidence of severe hypoglycaemia was 7.8 and
moderate was 15.4 episodes/100 patient years. Over the four years mean
(SD) clinic HbA1c steadily fell from 10.2 (1.6)% in 1992 to 8.8 (1.5)% in 1995. In parallel with this there was a dramatic increase in the rate of hypoglycaemia, especially in the fourth year of
the study, when severe hypoglycaemia increased from 4.8 to 15.6 episodes/100 patient years. This increase was particularly marked in
younger children (<6 years) in whom severe hypoglycaemia increased
from 14.9 to 42.1 episodes/100 patient years in 1995.
It is concluded that attempts to achieve improved metabolic
control must be accompanied by efforts to minimise the effects of
significant hypoglycaemia, particularly in the younger age group.
© 1998 by Archives of Disease in Childhood
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