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Hatle H, Skrivarhaug T, Bjørgaas MR, Åsvold BO, Rø TB. 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; 209:111093. [PMID: 38224875 DOI: 10.1016/j.diabres.2024.111093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 01/17/2024]
Abstract
AIMS 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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Affiliation(s)
- Håvard Hatle
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; Children's Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Torild Skrivarhaug
- Division of Paediatric and Adolescence Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Oslo Diabetes Research Centre, Oslo University Hospital, Oslo, Norway
| | - Marit R Bjørgaas
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; Department of Endocrinology, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Bjørn O Åsvold
- Department of Endocrinology, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Torstein B Rø
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; Children's Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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2
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Abraham MB, Karges B, Dovc K, Naranjo D, Arbelaez AM, Mbogo J, Javelikar G, Jones TW, Mahmud FH. ISPAD Clinical Practice Consensus Guidelines 2022: Assessment and management of hypoglycemia in children and adolescents with diabetes. Pediatr Diabetes 2022; 23:1322-1340. [PMID: 36537534 PMCID: PMC10107518 DOI: 10.1111/pedi.13443] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Mary B Abraham
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia.,Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia.,Discipline of Pediatrics, Medical School, The University of Western Australia, Perth, Australia
| | - Beate Karges
- Division of Endocrinology and Diabetes, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Klemen Dovc
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, UMC - University Children's Hospital, Ljubljana, Slovenia, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Diana Naranjo
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Ana Maria Arbelaez
- Division of Endocrinology and Diabetes, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Joyce Mbogo
- Department of Pediatric and Child Health, Aga Khan University Hospital, Nairobi, Kenya
| | - Ganesh Javelikar
- Department of Endocrinology and Diabetes, Max Super Speciality Hospital, New Delhi, India
| | - Timothy W Jones
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia.,Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia.,Discipline of Pediatrics, Medical School, The University of Western Australia, Perth, Australia
| | - Farid H Mahmud
- Division of Endocrinology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
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3
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Messaaoui A, Tenoutasse S, Hajselova L, Crenier L. Comparison Between Continuous Versus Flash Glucose Monitoring in Children, Adolescents, and Young Adults with Type 1 Diabetes: An 8-Week Prospective Randomized Trial. Diabetes Ther 2022; 13:1671-1681. [PMID: 35870074 PMCID: PMC9399330 DOI: 10.1007/s13300-022-01297-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/01/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION To assess the impact of real-time continuous glucose monitoring (RT-CGM) instead of first-generation flash glucose monitoring (FGM) on hypoglycaemia in children and adolescents with type 1 diabetes. METHODS In this randomized controlled interventional study, young individuals with type 1 diabetes used RT-CGM or FGM for 8 weeks. We evaluated changes in time below range (TBR), severe hypoglycaemia (SH), HbA1c, glycaemic variability, and impaired awareness of hypoglycaemia with RT-CGM (intervention group) in comparison with FGM. RESULTS We randomly assigned 37 participants to either the intervention group (n = 19) or the control group (n = 18). At 8 weeks, we did not find a decrease in TBR in either group, but there was a significant reduction in SH in the intervention group. For participants with TBR ≥ 5% at baseline, we observed significant reductions in 24-h TBR, wake TBR, sleep TBR, and glucose variability at 8 weeks in the intervention group. CONCLUSIONS The use of RT-CGM versus FGM decreased SH in young individuals with type 1 diabetes, and TBR and glucose variability in patients with a higher TBR at baseline. The patient's history should be taken into account when advising on the method of blood glucose monitoring, as RT-CGM could be more effective in younger patients at high risk for SH. TRIAL REGISTRATION ClinicalTrials.gov NCT04249102.
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Affiliation(s)
- Anissa Messaaoui
- Diabetology Clinic, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles (ULB), HUDERF, 15 Jean-Joseph Crocq avenue, 1020 Brussels, Belgium
| | - Sylvie Tenoutasse
- Diabetology Clinic, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles (ULB), HUDERF, 15 Jean-Joseph Crocq avenue, 1020 Brussels, Belgium
| | - Lucia Hajselova
- Diabetology Clinic, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles (ULB), HUDERF, 15 Jean-Joseph Crocq avenue, 1020 Brussels, Belgium
| | - Laurent Crenier
- Department of Endocrinology, Hôpital Erasme, Université Libre de Bruxelles (ULB), 808 Lennik Route, 1070 Brussels, Belgium
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4
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Farhat R, Aiken J, D'Souza NC, Appadurai D, Hull G, Simonson E, Liggins RT, Riddell MC, Chan O. ZT-01: A novel somatostatin receptor 2 antagonist for restoring the glucagon response to hypoglycaemia in type 1 diabetes. Diabetes Obes Metab 2022; 24:908-917. [PMID: 35060297 DOI: 10.1111/dom.14652] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/02/2022] [Accepted: 01/16/2022] [Indexed: 01/17/2023]
Abstract
AIM To evaluate the pharmacokinetics and efficacy of a novel somatostatin receptor 2 antagonist, ZT-01, to stimulate glucagon release in rats with type 1 diabetes (T1D). METHODS The pharmacokinetics of ZT-01 and PRL-2903 were assessed following intraperitoneal or subcutaneous dosing at 10 mg/kg. We compared the efficacy of ZT-01 with PRL-2903 to prevent hypoglycaemia during an insulin bolus challenge and under hypoglycaemic clamp conditions. RESULTS Within 1 hour after intraperitoneal administration, ZT-01 achieved more than 10-fold higher plasma Cmax compared with PRL-2903. Twenty-four hour exposure was 4.7× and 11.3× higher with ZT-01 by the intraperitoneal and subcutaneous routes, respectively. The median time to reach hypoglycaemia of more than 3.0 mmol/L was 60, 70, and 125 minutes following vehicle, PRL-2903, or ZT-01 administration, respectively. Furthermore, rats receiving ZT-01 had significantly higher glucose nadirs following insulin administration compared with PRL-2903- and vehicle-treated rats. During the hypoglycaemic clamp, ZT-01 increased peak glucagon responses by ~4-fold over PRL-2903. CONCLUSIONS We conclude that ZT-01 may be effective in restoring glucagon responses and preventing the onset of hypoglycaemia in patients with T1D.
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Affiliation(s)
- Rawad Farhat
- Department of Internal Medicine, Division of Endocrinology, Metabolism and Diabetes, University of Utah, Salt Lake City, Utah, USA
| | - Julian Aiken
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Ninoschka C D'Souza
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Daniel Appadurai
- Department of Internal Medicine, Division of Endocrinology, Metabolism and Diabetes, University of Utah, Salt Lake City, Utah, USA
| | - Grayson Hull
- Department of Internal Medicine, Division of Endocrinology, Metabolism and Diabetes, University of Utah, Salt Lake City, Utah, USA
| | - Eric Simonson
- Zucara Therapeutics, Vancouver, British Columbia, Canada
| | | | - Michael C Riddell
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
- Zucara Therapeutics, Vancouver, British Columbia, Canada
| | - Owen Chan
- Department of Internal Medicine, Division of Endocrinology, Metabolism and Diabetes, University of Utah, Salt Lake City, Utah, USA
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5
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Hassounah G, Abdullah Aljohani AE, Al Sharhani R, Al Aljoulni M, Robert AA, Al Goudah AH, Al Turki AA. Prevalence of impaired awareness of hypoglycemia and its risk factors among patients with type 1 diabetes in Saudi Arabia. Diabetes Metab Syndr 2022; 16:102351. [PMID: 34920195 DOI: 10.1016/j.dsx.2021.102351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/17/2021] [Accepted: 11/23/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS To determine the prevalence of impaired awareness of hypoglycemia (IHA) and self-identification of symptoms in patients with type 1 diabetes (T1D). METHODS A cross-sectional study was conducted on 242 patients with T1D at the Diabetes Treatment Center, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia from May 2021 to September 2021. In addition to the demographic data, patients' HbA1c level was also collected. Awareness and symptoms of hypoglycemia were assessed using two validated questionnaire-based methods, namely the Gold and Edinburgh methods. RESULTS The prevalence of IAH among patients with T1D was 62.8% and the presence of IAH was significantly associated with the duration of T1D (p = 0.019). Compared to males, females had significantly higher (p < 0.05) levels of warmth, pounding heart, and inability to concentrate. Compared to unmarried, married patients had significantly higher levels of (p < 0.05) drowsiness, dizziness, and blurred vision. Similarly, compared to school educated, college-educated showed a higher hunger level (p < 0.05). Patients with HbA1c ≥ 7% possess a significantly higher level of drowsiness, dizziness, and hunger. Dizziness, warmth, difficulty speaking, pounding heart, and blurred vision were significantly higher among patients with diabetes duration ≥10 yrs. Nausea was significantly higher among smokers than non-smokers (p < 0.05). CONCLUSION The prevalence of IAH is high among patients with T1D in Saudi Arabia. Focused and evidence-based interventions are essential to minimize the hypoglycemia risk among patients with T1D.
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Affiliation(s)
- Ghadeer Hassounah
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - Amal Eid Abdullah Aljohani
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - Reham Al Sharhani
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - Momen Al Aljoulni
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - Asirvatham Alwin Robert
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - Al Hanouf Al Goudah
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - Al Anoud Al Turki
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
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6
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Grunberger G, Sherr J, Allende M, Blevins T, Bode B, Handelsman Y, Hellman R, Lajara R, Roberts VL, Rodbard D, Stec C, Unger J. American Association of Clinical Endocrinology Clinical Practice Guideline: The Use of Advanced Technology in the Management of Persons With Diabetes Mellitus. Endocr Pract 2021; 27:505-537. [PMID: 34116789 DOI: 10.1016/j.eprac.2021.04.008] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To provide evidence-based recommendations regarding the use of advanced technology in the management of persons with diabetes mellitus to clinicians, diabetes-care teams, health care professionals, and other stakeholders. METHODS The American Association of Clinical Endocrinology (AACE) conducted literature searches for relevant articles published from 2012 to 2021. A task force of medical experts developed evidence-based guideline recommendations based on a review of clinical evidence, expertise, and informal consensus, according to established AACE protocol for guideline development. MAIN OUTCOME MEASURES Primary outcomes of interest included hemoglobin A1C, rates and severity of hypoglycemia, time in range, time above range, and time below range. RESULTS This guideline includes 37 evidence-based clinical practice recommendations for advanced diabetes technology and contains 357 citations that inform the evidence base. RECOMMENDATIONS Evidence-based recommendations were developed regarding the efficacy and safety of devices for the management of persons with diabetes mellitus, metrics used to aide with the assessment of advanced diabetes technology, and standards for the implementation of this technology. CONCLUSIONS Advanced diabetes technology can assist persons with diabetes to safely and effectively achieve glycemic targets, improve quality of life, add greater convenience, potentially reduce burden of care, and offer a personalized approach to self-management. Furthermore, diabetes technology can improve the efficiency and effectiveness of clinical decision-making. Successful integration of these technologies into care requires knowledge about the functionality of devices in this rapidly changing field. This information will allow health care professionals to provide necessary education and training to persons accessing these treatments and have the required expertise to interpret data and make appropriate treatment adjustments.
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Affiliation(s)
| | - Jennifer Sherr
- Yale University School of Medicine, New Haven, Connecticut
| | - Myriam Allende
- University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | | | - Bruce Bode
- Atlanta Diabetes Associates, Atlanta, Georgia
| | | | - Richard Hellman
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | | | | | - David Rodbard
- Biomedical Informatics Consultants, LLC, Potomac, Maryland
| | - Carla Stec
- American Association of Clinical Endocrinology, Jacksonville, Florida
| | - Jeff Unger
- Unger Primary Care Concierge Medical Group, Rancho Cucamonga, California
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7
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Abstract
Hypoglycaemia (blood glucose concentration below the normal range) has been recognised as a complication of insulin treatment from the very first days of the discovery of insulin, and remains a major concern for people with diabetes, their families and healthcare professionals today. Acute hypoglycaemia stimulates a stress response that acts to restore circulating glucose, but plasma glucose concentrations can still fall too low to sustain normal brain function and cardiac rhythm. There are long-term consequences of recurrent hypoglycaemia, which are still not fully understood. This paper reviews our current understanding of the acute and cumulative consequences of hypoglycaemia in insulin-treated diabetes.
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Affiliation(s)
- Stephanie A Amiel
- Department of Diabetes, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
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8
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Hatle H, Bjørgaas MR, Skrivarhaug T, Åsvold BO, Graveling AJ, Frier BM, Rø TB. Assessing awareness of hypoglycemia in children and adolescents with type 1 diabetes: Evaluation of established questionnaires. Pediatr Diabetes 2020; 21:300-309. [PMID: 31788937 DOI: 10.1111/pedi.12951] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 09/12/2019] [Accepted: 11/05/2019] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To evaluate the use of two questionnaires assessing awareness of hypoglycemia, in a pediatric type 1 diabetes (T1D) population. METHODS Prospective observational study with children (aged 9-18 years) and parents (for children aged 2-11 years) answering the Gold and Clarke questionnaires assessing awareness of hypoglycemia. Psychometric properties of the questionnaires were evaluated, and the most appropriate cut-off score to classify participants as having normal vs impaired awareness of hypoglycemia (IAH) was determined by ability to recognize subsequent hypoglycemia and hypoglycemia severity, documented in a 4-week blood glucose diary. Questionnaires were readministered at follow-up assessment approximately 1.5 years later. RESULTS In total, 112 participants (51% male) with median (IQR) age 13.7 (11.1-15.8) years, T1D duration 4.7 (2.2-7.8) years, and HbA1c 62 (57-73) mmol/mol (7.8%) were included. Both questionnaires demonstrated acceptable psychometric properties. Using score ≥3 to classify IAH gave a prevalence of IAH of 41% (Gold) and 22% (Clarke). When classified using the Gold questionnaire, IAH participants had higher incidences of mild asymptomatic hypoglycemia, whereas with the Clarke questionnaire, they had higher incidences of clinically significant and severe hypoglycemia. Subgroup analyses confirmed these associations only in participants aged ≥9 years. Follow-up was completed in 90% of the participants, and a change of awareness status was observed in 22% to 36%. CONCLUSIONS The Gold and Clarke questionnaires may be used to assess awareness of hypoglycemia in pediatric T1D in those ≥9 years of age, but the more detailed Clarke questionnaire has higher specificity and is superior in predicting risk of clinically significant hypoglycemia.
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Affiliation(s)
- Håvard Hatle
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Children's Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marit R Bjørgaas
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Endocrinology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Torild Skrivarhaug
- Division of Paediatric and Adolescence Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Oslo Diabetes Research Centre, Oslo University Hospital, Oslo, Norway
| | - Bjørn O Åsvold
- Department of Endocrinology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Alex J Graveling
- JJR Macleod Centre for Diabetes & Endocrinology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Brian M Frier
- The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Torstein B Rø
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Children's Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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9
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van Meijel LA, de Vegt F, Abbink EJ, Rutters F, Schram MT, van der Klauw MM, Wolffenbuttel BHR, Siegelaar S, DeVries JH, Sijbrands EJG, Özcan B, de Valk HW, Silvius B, Schaper N, Stehouwer CDA, Elders PJM, Tack CJ, de Galan BE. High prevalence of impaired awareness of hypoglycemia and severe hypoglycemia among people with insulin-treated type 2 diabetes: The Dutch Diabetes Pearl Cohort. BMJ Open Diabetes Res Care 2020; 8:8/1/e000935. [PMID: 32107264 PMCID: PMC7206921 DOI: 10.1136/bmjdrc-2019-000935] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/03/2019] [Accepted: 12/15/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE People with type 2 diabetes on insulin are at risk for hypoglycemia. Recurrent hypoglycemia can cause impaired awareness of hypoglycemia (IAH), and increase the risk for severe hypoglycemia. The aim of this study was to assess the prevalence and determinants of self-reported IAH and severe hypoglycemia in a Dutch nationwide cohort of people with insulin-treated type 2 diabetes. RESEARCH DESIGN AND METHODS Observational study of The Dutch Diabetes Pearl, a cohort of people with type 2 diabetes treated in primary, secondary and tertiary diabetes care centers. The presence of IAH and the occurrence of severe hypoglycemia in the past year, defined as an event requiring external help to recover, were assessed using the validated Dutch version of the Clarke questionnaire. In addition, clinical variables were collected including age, diabetes duration, hemoglobin A1c, ethnicity and education. RESULTS 2350 people with type 2 diabetes on insulin were included: 59.1% men, mean age 61.1±10.4 years, mean diabetes duration 14.8±9.2 years and 79.5% on basal-bolus therapy. A total of 229 patients (9.7%) were classified as having IAH and 742 patients (31.6%) reported severe hypoglycemia. Increased odds for IAH were found with complex insulin regimens and lower odds with having a partner and body mass index ≥30 kg/m2. Severe hypoglycemia was associated with complex insulin regimens, non-Caucasian ethnicity and use of psychoactive drugs, and inversely with metformin use. CONCLUSIONS In this nationwide cohort, almost one out of ten people with type 2 diabetes on insulin had IAH and >30% had a history of severe hypoglycemia in the past year.
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Affiliation(s)
- Lian A van Meijel
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Femmie de Vegt
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Evertine J Abbink
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Femke Rutters
- Department of Epidemiology & Biostatistics, Amsterdam UMC - Locatie VUMC, Amsterdam, The Netherlands
| | - Miranda T Schram
- Department of Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Melanie M van der Klauw
- Department of Endocrinology, University Medical Center Groningen, Groningen, The Netherlands
| | - Bruce H R Wolffenbuttel
- Department of Endocrinology, University Medical Center Groningen, Groningen, The Netherlands
| | - Sarah Siegelaar
- Department of Internal Medicine, Amsterdam UMC - Locatie AMC, Amsterdam, The Netherlands
| | - J Hans DeVries
- Department of Internal Medicine, Amsterdam UMC - Locatie AMC, Amsterdam, The Netherlands
| | | | - Behiye Özcan
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Harold W de Valk
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bianca Silvius
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nicolaas Schaper
- Department of Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Coen D A Stehouwer
- Department of Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Petra J M Elders
- Department of General Practice and Elderly Care, Amsterdam Public Health Research Institute, Amsterdam UMC - Locatie VUMC, Amsterdam, The Netherlands
| | - Cornelis J Tack
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bastiaan E de Galan
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
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10
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Alkhatatbeh MJ, Abdalqader NA, Alqudah MAY. Impaired awareness of hypoglycemia in children and adolescents with type 1 diabetes mellitus in north of Jordan. BMC Endocr Disord 2019; 19:107. [PMID: 31651281 PMCID: PMC6814051 DOI: 10.1186/s12902-019-0441-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/09/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Hypoglycemia is a common complication of insulin therapy in patients with Type 1 Diabetes Mellitus (DM). Awareness of hypoglycemic symptoms helps patients to recognize hypoglycemia and initiate self-treatment. Impaired Awareness of Hypoglycemia (IAH) exposes patients to severe hypoglycemia, which could be associated with seizures and unconsciousness. This study aimed to assess IAH, frequency of hypoglycemia, severe hypoglycemia and intensity of hypoglycemic symptoms among children and adolescents with Type 1 DM in North of Jordan. METHODS Data were collected from 94 children and adolescents with Type 1 DM. Clarke's and Edinburgh surveys were used to assess IAH and individual symptoms of hypoglycemia, respectively. Frequency of hypoglycemia and other related information were obtained by self-reporting or from medical records. RESULTS 16.0% of participants were having IAH, 66.0% of participants reported recurrent hypoglycemia (>once/month) and 18.0% of participants developed ≥1 severe hypoglycemia during the previous year. IAH was not associated with age, gender, duration of DM, HbA1c, insulin regimen, adherence to insulin or development of severe hypoglycemia (p-values> 0.05). Instead, IAH was associated with frequency of hypoglycemia during the previous 6 months (p-value< 0.01). Hunger, tiredness, dizziness, drowsiness, inability to concentrate, trembling and weakness were the most common symptoms felt by participants when they develop hypoglycemia. Hunger was the only common symptom that was significantly higher in children compared to adolescent (p-value < 0.01). CONCLUSIONS This study has reported low prevalence of IAH in children and adolescents with Type 1 DM in North of Jordan. IAH was more common in subjects with more frequent hypoglycemia.
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Affiliation(s)
- Mohammad J Alkhatatbeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan.
| | - Nedaa A Abdalqader
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Mohammad A Y Alqudah
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
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Elvebakk O, Tronstad C, Birkeland KI, Jenssen TG, Bjørgaas MR, Gulseth HL, Kalvøy H, Høgetveit JO, Martinsen ØG. A multiparameter model for non-invasive detection of hypoglycemia. Physiol Meas 2019; 40:085004. [PMID: 31357185 DOI: 10.1088/1361-6579/ab3676] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Severe hypoglycemia is the most serious acute complication for people with type 1 diabetes (T1D). Approximately 25% of people with T1D have impaired ability to recognize impending hypoglycemia, and nocturnal episodes are feared. APPROACH We have investigated the use of non-invasive sensors for detection of hypoglycemia based on a mathematical model which combines several sensor measurements to identify physiological responses to hypoglycemia. Data from randomized single-blinded euglycemic and hypoglycemic glucose clamps in 20 participants with T1D and impaired awareness of hypoglycemia was used in the analyses. MAIN RESULTS Using a sensor combination of sudomotor activity at three skin sites, ECG-derived heart rate and heart rate corrected QT interval, near-infrared and bioimpedance spectroscopy; physiological responses associated with hypoglycemia could be identified with an F1 score accuracy up to 88%. SIGNIFICANCE We present a novel model for identification of non-invasively measurable physiological responses related to hypoglycemia, showing potential for detection of moderate hypoglycemia using a wearable sensor system.
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Affiliation(s)
- Ole Elvebakk
- Department of Clinical and Biomedical Engineering, Oslo University Hospital, Oslo, Norway
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12
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Demir G, Özen S, Çetin H, Darcan Ş, Gökşen D. Effect of Education on Impaired Hypoglycemia Awareness and Glycemic Variability in Children and Adolescents with Type 1 Diabetes Mellitus. J Clin Res Pediatr Endocrinol 2019; 11:189-195. [PMID: 30701953 PMCID: PMC6571530 DOI: 10.4274/jcrpe.galenos.2019.2019.0009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE The aim of this study was to determine the prevalence of impaired hypoglycemia awareness (IHA) in children and adolescents with type 1 diabetes mellitus using a professional continuous glucose monitoring (CGM) system and to show the effect of structured education on glycemic variability (GV) in children and adolescents with IHA. METHODS Forty type 1 diabetic children and adolescents with a diabetes duration of at least five years were eligible for inclusion in this prospective, quantitative study. All subjects were asked about their history of being aware of the symptoms of hypoglycemia using a questionnaire. Professional CGM was conducted in all of the patients for six days. The frequency of IHA detected by comparison of CGM and logbook reports were analyzed. Patients with identified IHA underwent a structured training program. After three months, CGM was re-applied to patients with IHA. RESULTS The study was completed by 37 diabetic children and adolescents. After the initial CGM, nine patients (24.3%) were found to have had episodes of IHA. Area under the curve (AUC) for hypoglycemia and number of low excursions were; 1.81±0.95 and 8.33±3.60 for the IHA group at the beginning of the study. AUC for hypoglycemia was 0.43±0.47 after three months of structured education the IHA patients (p=0.01). Coefficient of variation which shows primary GV decreased significantly although unstable at the end of education in IHA patients (p=0.03). CONCLUSION CGM is a valuable tool to diagnose IHA. IHA, GV and time in range can be improved by education-based intervention.
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Affiliation(s)
- Günay Demir
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, İzmir, Turkey
| | - Samim Özen
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, İzmir, Turkey,* Address for Correspondence: Ege University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, İzmir, Turkey Phone: +90 232 390 12 30 E-mail:
| | - Hafize Çetin
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, İzmir, Turkey
| | - Şükran Darcan
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, İzmir, Turkey
| | - Damla Gökşen
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, İzmir, Turkey
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13
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Alkhatatbeh MJ, Abdalqader NA, Alqudah MAY. Impaired Awareness of Hypoglycaemia in Insulin-treated Type 2 Diabetes Mellitus. Curr Diabetes Rev 2019; 15:407-413. [PMID: 30081789 DOI: 10.2174/1573399814666180806144937] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 08/01/2018] [Accepted: 08/03/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patients with Type 2 Diabetes Mellitus (T2DM) may develop hypoglycemia as an adverse effect of insulin therapy. Hypoglycemia has dangerous consequences that result from neuroglycopenia and hypersecretion of counter-regulatory hormones. Patients who recognize early symptoms of hypoglycemia can initiate self-treatment and rectify the situation. Impaired Awareness of Hypoglycemia (IAH) predisposes patients to severe hypoglycemia and unconsciousness. OBJECTIVE To assess the prevalence of IAH, the intensity of hypoglycaemic symptoms, the frequency of severe hypoglycemia and factors associated with IAH in patients with insulin-treated T2DM. METHODS This is a cross-sectional study that used Clarke's and Gold's surveys to assess IAH and Edinburgh survey to assess the intensity of hypoglycemic symptoms in patients with insulin-treated T2DM (n= 388). The frequency of hypoglycemia and other data were collected by self-reporting or from medical records. RESULTS The prevalence (95% confidence interval) of IAH was 17.01% (13.27%-20.75%) as determined by Clarke's method and 5.93% (3.58-8.28) by Gold's method (Odds= 3.25, p-value<0.00001). Drowsiness, hunger, sweating, tiredness, trembling and weakness, were the most intense hypoglycaemic symptoms, and 6.19% of participants reported at least one episode of severe hypoglycaemia within the past year. Regardless of classification method used, IAH is not dependent on age, gender, duration of T2DM or duration of insulin therapy (p-values>0.05). Instead, IAH is positively associated with frequency of hypoglycaemia during the previous six months (p-value<0.05) and development of severe hypoglycaemia within the past year (p-value <0.05). CONCLUSION This study highlights large variability in IAH depending on the method used for assessment. Increased hypoglycaemia frequency may increase the prevalence of IAH and thus the development of severe hypoglycemia.
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Affiliation(s)
- Mohammad J Alkhatatbeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Nedaa A Abdalqader
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Mohammad A Y Alqudah
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
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14
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Van Name MA, Hilliard ME, Boyle CT, Miller KM, DeSalvo DJ, Anderson BJ, Laffel LM, Woerner SE, DiMeglio LA, Tamborlane WV. Nighttime is the worst time: Parental fear of hypoglycemia in young children with type 1 diabetes. Pediatr Diabetes 2018; 19:114-120. [PMID: 28429581 PMCID: PMC5650950 DOI: 10.1111/pedi.12525] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 03/03/2017] [Accepted: 03/06/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Fear of hypoglycemia is common in parents of young children with type 1 diabetes (T1D), but little is known about the specific fears that parents most often experience. Hypoglycemia fear has been associated with poorer glycemic control in older children, though not yet studied in a large cohort of very young children. MATERIALS AND METHODS Parents of 549 children <7 years (mean 5.2 ± 1.2 years [19% <3 years]) with a mean diabetes duration of 2.4 ± 1.0 years (range 1-6 years) and mean HbA1c 8.2% ± 1.1% (66 ± 12 mmol/mol) registered in the T1D Exchange completed the worry scale of the Hypoglycemia Fear Survey modified for parents (HFS-P). RESULTS Mean parental fear of hypoglycemia worry score was 36.1 ± 23.1 (possible range 0-100), with most frequent worries related to the child having a low while asleep and the child not recognizing a low. The mean worry score was not associated with the child's age, glycemic control, or recent severe hypoglycemic event. Parental worries about lows while sleeping were significantly higher in pump users than non-users (61% vs. 45%; P < .001), and tended to be higher in CGM users than non-users (62% vs 51%; P = .02). CONCLUSIONS The greatest worries of parents of young children with T1D were related to hypoglycemia during sleep and other times/circumstances during which it would be difficult to detect hypoglycemia. Using advanced diabetes technologies may be an effort to temper fears about hypoglycemia during sleep, though the directionality of this relationship is undetermined. Additional studies can clarify this association and leverage use of diabetes technologies to improve glycemic control.
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Affiliation(s)
| | - Marisa E. Hilliard
- Baylor College of Medicine and Texas Children’s Hospital, 1102 Bates Ave., Houston, TX 77030
| | - Claire T. Boyle
- Jaeb Center for Health Research, 15310 Amberly Drive, Suite 350, Tampa, FL 33647
| | - Kellee M. Miller
- Jaeb Center for Health Research, 15310 Amberly Drive, Suite 350, Tampa, FL 33647
| | - Daniel J. DeSalvo
- Baylor College of Medicine and Texas Children’s Hospital, 1102 Bates Ave., Houston, TX 77030
| | - Barbara J. Anderson
- Baylor College of Medicine and Texas Children’s Hospital, 1102 Bates Ave., Houston, TX 77030
| | - Lori M. Laffel
- Joslin Diabetes Center, One Joslin Place, Boston, MA 02215
| | - Stephanie E. Woerner
- Indiana University School of Medicine, Rm 5960, 705 Riley Hospital Drive, Indianapolis, IN 46202
| | - Linda A. DiMeglio
- Indiana University School of Medicine, Rm 5960, 705 Riley Hospital Drive, Indianapolis, IN 46202
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15
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Abraham MB, Gallego PH, Brownlee WM, Smith GJ, Davis EA, Jones TW. Reduced prevalence of impaired awareness of hypoglycemia in a population-based clinic sample of youth with type 1 diabetes. Pediatr Diabetes 2017; 18:729-733. [PMID: 27862736 DOI: 10.1111/pedi.12460] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/18/2016] [Accepted: 09/22/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Impaired awareness of hypoglycemia (IAH) is associated with an increased risk for severe hypoglycemia (SH). However, reduced rates of SH raise the question as to whether there has been a reduction in IAH. The aim of this study was to determine the change in prevalence of IAH in a population-based cohort of adolescents with Type 1 diabetes (T1D). METHODS Children older than 12 years with T1D documented their responses to hypoglycemia based on the modified Clarke questionnaire. The prevalence of IAH was also analyzed in a similar population-based cohort using the same questionnaire in 2002. The clinical details of the participants and the number of SH events in the preceding year were determined from the Western Australian diabetes database. RESULTS The questionnaire was administered to 413 children in 2002 and to 444 children in 2015 with similar baseline characteristics. The prevalence of IAH was 33% in 2002 and 21% in 2015 (P < .001). A lower HbA1c, younger age at diagnosis and longer duration of diabetes correlated with IAH in 2002 but not in 2015. There was a significant decline in the rates of SH in 2015 compared with 2002 (P < .001) despite a reduced HbA1c in 2015. IAH increased the risk of SH in both cohorts (52 vs 16 events/100 patient years in 2002 and 8 vs 2 events/100 patient years in 2015). CONCLUSIONS Although IAH has reduced, IAH is still prevalent in a substantial minority of adolescents and continues to be associated with an increased risk of SH.
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Affiliation(s)
- Mary B Abraham
- Department of Endocrinology and Diabetes, Princess Margaret Hospital, Perth, Australia.,School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia
| | - Patricia H Gallego
- Department of Endocrinology and Diabetes, Princess Margaret Hospital, Perth, Australia.,Lawson Health Research Institute, University of Western Ontario, London, Canada.,Children's Hospital, London Health Sciences Centre, London, Canada
| | - Wade M Brownlee
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Grant J Smith
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Elizabeth A Davis
- Department of Endocrinology and Diabetes, Princess Margaret Hospital, Perth, Australia.,School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Timothy W Jones
- Department of Endocrinology and Diabetes, Princess Margaret Hospital, Perth, Australia.,School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Australia
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16
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Hansen GL, Foli-Andersen P, Fredheim S, Juhl C, Remvig LS, Rose MH, Rosenzweig I, Beniczky S, Olsen B, Pilgaard K, Johannesen J. Hypoglycemia-Associated EEG Changes in Prepubertal Children With Type 1 Diabetes. J Diabetes Sci Technol 2016; 10:1222-1229. [PMID: 26920641 PMCID: PMC5094317 DOI: 10.1177/1932296816634357] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this study was to explore the possible difference in the electroencephalogram (EEG) pattern between euglycemia and hypoglycemia in children with type 1 diabetes (T1D) during daytime and during sleep. The aim is to develop a hypoglycemia alarm based on continuous EEG measurement and real-time signal processing. METHOD Eight T1D patients aged 6-12 years were included. A hyperinsulinemic hypoglycemic clamp was performed to induce hypoglycemia both during daytime and during sleep. Continuous EEG monitoring was performed. For each patient, quantitative EEG (qEEG) measures were calculated. A within-patient analysis was conducted comparing hypoglycemia versus euglycemia changes in the qEEG. The nonparametric Wilcoxon signed rank test was performed. A real-time analyzing algorithm developed for adults was applied. RESULTS The qEEG showed significant differences in specific bands comparing hypoglycemia to euglycemia both during daytime and during sleep. In daytime the EEG-based algorithm identified hypoglycemia in all children on average at a blood glucose (BG) level of 2.5 ± 0.5 mmol/l and 18.4 (ranging from 0 to 55) minutes prior to blood glucose nadir. During sleep the nighttime algorithm did not perform. CONCLUSIONS We found significant differences in the qEEG in euglycemia and hypoglycemia both during daytime and during sleep. The algorithm developed for adults detected hypoglycemia in all children during daytime. The algorithm had too many false alarms during the night because it was more sensitive to deep sleep EEG patterns than hypoglycemia-related EEG changes. An algorithm for nighttime EEG is needed for accurate detection of nocturnal hypoglycemic episodes in children. This study indicates that a hypoglycemia alarm may be developed using real-time continuous EEG monitoring.
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Affiliation(s)
| | - Pia Foli-Andersen
- Pediatric Department, Copenhagen University Hospital Herlev, Denmark
| | - Siri Fredheim
- Pediatric Department, Copenhagen University Hospital Herlev, Denmark
| | - Claus Juhl
- Hypo-Safe A/S, Lyngby, Denmark
- Department of Medicine, Hospital of South West Denmark, Esbjerg, Denmark
| | | | | | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, King's College London, London, UK
- Sleep Disorders Centre, Guy's and St Thomas's Hospitals NHS Trust, London, UK
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Center, Dianalund, Denmark
- Aarhus University, Århus, Denmark
| | - Birthe Olsen
- Pediatric Department, Copenhagen University Hospital Herlev, Denmark
| | - Kasper Pilgaard
- Pediatric Department, Copenhagen University Hospital, Hillerød, Denmark
| | - Jesper Johannesen
- Pediatric Department, Copenhagen University Hospital Herlev, Denmark
- Faculty of Health and Medical Sciences, Copenhagen University, Denmark
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17
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Amin A, Lau L, Crawford S, Edwards A, Pacaud D. Prospective assessment of hypoglycemia symptoms in children and adults with type 1 diabetes. Can J Diabetes 2015; 39 Suppl 4:26-31. [PMID: 26541488 DOI: 10.1016/j.jcjd.2015.09.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 05/16/2014] [Accepted: 05/21/2014] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare the characteristics of symptoms of hypoglycemia in children and in adults with type 1 diabetes. METHODS Adults with diabetes and parents of children with diabetes who were participants were asked to call a phone system to report episodes of hypoglycemia (presence of symptoms and a blood glucose <4.0 mmol/L). For each episode, blood glucose reading and a scoring of 28 symptoms on a 7-point scale (1 = not present, 7 = very intense) were collected. RESULTS Sixty six children (49.2% males, mean age = 12.1±2.4 years, mean age at diagnosis = 7.5±2.9 years) and 53 adults (41.2% males, mean age 38.7±14.5 years, mean age at diagnosis = 17.5±12.9 years) with type 1 diabetes participated. The most common symptoms in adults were hunger, sweating, trembling and weakness. The most common symptoms in children were weakness, trembling and hunger. The 2 most discriminating variables between children and adults were sleepiness and tiredness, which were more common in children (p<0.01). In a comparative factor analysis, 3 factors emerged: factor 1, autonomic and neuroglycopenic; factor 2, behavioural; and factor 3, general malaise. Factors 2 and 3 were significantly more common or intense in children than in adults; MANOVA: F(1, 113) = 6.72, p<0.05 and F(1, 113) = 4.64, p<0.05, respectively. CONCLUSIONS Symptoms relating to behaviour and general malaise are more common in children than in adults with type 1 diabetes. The results of this study may assist providers in educating caregivers of children and patients with diabetes how to better recognize episodes of hypoglycemia.
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Affiliation(s)
- Aditi Amin
- Section of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Lorraine Lau
- Section of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Susan Crawford
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Alun Edwards
- Section of Endocrinology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Danièle Pacaud
- Section of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
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18
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Abstract
Hypoglycemia caused by treatment with a sulfonylurea, a glinide, or insulin coupled with compromised defenses against the resulting falling plasma glucose concentrations is a problem for many people with diabetes. It is often recurrent, causes significant morbidity and occasional mortality, limits maintenance of euglycemia, and impairs physiological and behavioral defenses against subsequent hypoglycemia. Minimizing hypoglycemia includes acknowledging the problem; considering each risk factor; and applying the principles of intensive glycemic therapy, including drug selection and selective application of diabetes treatment technologies. For diabetes health-care providers treating most people with diabetes who are at risk for or are suffering from iatrogenic hypoglycemia, these principles include selecting appropriate individualized glycemic goals and providing structured patient education to reduce the incidence of hypoglycemia. This is typically combined with short-term scrupulous avoidance of hypoglycemia, which often will reverse impaired awareness of hypoglycemia. Clearly, the risk of hypoglycemia is modifiable.
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19
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Amin A, Lau L, Crawford S, Edwards A, Pacaud D. Prospective assessment of hypoglycemia symptoms in children and adults with type 1 diabetes. Can J Diabetes 2014; 38:263-8. [PMID: 25023739 DOI: 10.1016/j.jcjd.2014.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 05/16/2014] [Accepted: 05/21/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE To compare the characteristics of symptoms of hypoglycemia in children and in adults with type 1 diabetes. METHODS Adults with diabetes and parents of children with diabetes who were participants were asked to call a phone system to report episodes of hypoglycemia (presence of symptoms and a blood glucose <4.0 mmol/L). For each episode, blood glucose reading and a scoring of 28 symptoms on a 7-point scale (1 = not present, 7 = very intense) were collected. RESULTS Sixty six children (49.2% males, mean age = 12.1±2.4 years, mean age at diagnosis = 7.5±2.9 years) and 53 adults (41.2% males, mean age 38.7±14.5 years, mean age at diagnosis = 17.5±12.9 years) with type 1 diabetes participated. The most common symptoms in adults were hunger, sweating, trembling and weakness. The most common symptoms in children were weakness, trembling and hunger. The 2 most discriminating variables between children and adults were sleepiness and tiredness, which were more common in children (p<0.01). In a comparative factor analysis, 3 factors emerged: factor 1, autonomic and neuroglycopenic; factor 2, behavioural; and factor 3, general malaise. Factors 2 and 3 were significantly more common or intense in children than in adults; MANOVA: F(1, 113) = 6.72, p<0.05 and F(1, 113) = 4.64, p<0.05, respectively. CONCLUSIONS Symptoms relating to behaviour and general malaise are more common in children than in adults with type 1 diabetes. The results of this study may assist providers in educating caregivers of children and patients with diabetes how to better recognize episodes of hypoglycemia.
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Affiliation(s)
- Aditi Amin
- Section of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Lorraine Lau
- Section of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Susan Crawford
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Alun Edwards
- Section of Endocrinology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Danièle Pacaud
- Section of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
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