Severe hypoglycemia, metabolic control, and diabetes management in young children with type 1 diabetes using insulin analogs—a follow-up report of a large multicenter database

Abstract

Good metabolic control without hypoglycemia remains a challenging goal in pediatric diabetes care [1]. We reported about metabolic control and hypoglycemia in children with type 1 diabetes. Significant predictors of hypoglycemia were younger age, longer diabetes duration, higher insulin dose, injection regimen, and center experience [6]. Since the underlying DPV database covered the years 1993–2003, we could not provide data on insulin analogs. Therefore 7,266 patients (52% boys) with type 1 diabetes were now investigated for the years 2000–2005 using the same diabetes software DPV for data acquisition. For each patient, all records from the most recent year of therapy were aggregated. The mean age was 6.5±1.9 years, insulin dose/kg body weight 0.68 U±0.23, number of daily injections 3.4±1.0, percentage of patients on short-acting analogs 14.5%, and percentage of patients on long-acting analogs 9.6%. The SAS program package (version 9.1, SAS Institute, Cary, NC, USA) was used for analysis. Severe hypoglycemia was defined using the International Society for Pediatric and Adolescent Diabetes (ISPAD) classification [3]. Grade 2 hypoglycemias were moderate episodes that involved neurological dysfunction. The child or adolescent could not respond and required help from someone else, but oral treatment was successful. Grade 3 hypoglycemias were associated with severe neurological dysfunction (e.g., seizures, loss of consciousness, disorientation, inability to arouse from sleep) that required intervention with glucagon or intravenous glucose. The mean HbA1c (standardized to the Diabetes Control and Complications Trial) was 7.66±1.3%. Severe hypoglycemia per 100 patient years according to grade 2 or 3 ISPAD classification was 26.3±1.3 (grade 3 hypoglycemia only: 3.5±0.5), and the rate of diabetic ketoacidosis (DKA) was 3.0±0.3 per 100 patient years. The average daily injection frequency increased between 2000 and 2005 in the different age groups: 2.8–3.5 (age <5=I), 2.9–3.7 (age 5–<7=II), 3.1–3.9 (age 7–<9=III). The use of a shortacting analog increased during the same period: 9.3–22.9% (I), 5.9–16.7% (II), 4.2–13.5% (III), as did the use of a long-acting analog: 0.7–4.6% (I), 0.8–11.1% (II), 0.7– 15.2% (III). A decreasing rate for grade 2 or 3 hypoglycemia was detected: 43.7–38.6 (I), 29.8–19.5 (II), 31.5–21.2 (III) [grade 3 hypoglycemia: 5.2–1.9 (I), 5.4–2.1 (II) with a Eur J Pediatr (2008) 167:241–242 DOI 10.1007/s00431-007-0446-7