Impaired Hypoglycemia Awareness in Children and Adolescents with Type 1 Diabetes and its Association with Diabetic Autonomic Neuropathy

Abstract

Abstract Background In general, hypoglycemia is more frequent among the young explaining the higher frequency of impaired awareness of hypoglycemia (IAH) among children andadolescents. Thus the aim of the current study was to assess the frequency of IAH among anEgyptian cohort of children and adolescents with type 1 diabetes and identify the possible association between impaired awareness of hypoglycemia and autonomic neuropathy. Patients and Methods A crosssectional study recruiting 100 patients with type 1 diabetesfor at least 6 months duration and aged less than 18 years old recruited from the Pediatric and Adolescent Diabetes Unit (PADU). Patients with other form of diabetes, cardiac disease,thyroid disease, anemia, other chronic disease, patients with intellectual disabilities or patients taking any medications were excluded from the study. The Gold and Clarke questionnaires were used to assess hypoglycemia awareness among the studied cohort.Cardiac autonomic neuropathy (CAN) was assessed using 15 minutes Holterelectrocardiography (ECG). Results Among the studied cohort, 42% showed IAH using theClarke’s and Gold's Questionnaires. When assessing CAN, 46% of the studied cohort showedresting tachycardia and patients with resting tachycardia showed significantly longer diseaseduration.There were no normative heart rate variability parameters values for the Egyptian children that can be used as a reference for diagnosis of cardiac autonomic neuropathy. So weused sex and age matched control group to find specific cutoff values for heart rate variabilityparameters to diagnose CAN. The results showed that the prevalence of CAN among studiedpatients was 88% and there were no significant correlation between CAN and both questionnaires score. 55.7% of CAN patients were aware while 44.3% were unaware. Thus,there were no association between impaired awareness of hypoglycemia and CAN. Theresults showed that there was significant positive correlation between cardiac autonomicneuropathy (CAN) and diabetic duration more than 5 years. Conclusion Although there were no association between impaired awareness of hypoglycemia and cardiac autonomic neuropathy, it is important to screen for CAN in patients with IAH, especially that CAN isusually asymptomatic among children with type 1 diabetes.