[ Diabetes Type 1 ]

Hypoglycemia in children with type 1 diabetes: unawareness is a concrete risk: Current Medical Research

The Diabetes Control and Complications Trial demonstrated that in patients with type 1 diabetes, tight metabolic control achieved with intensive insulin therapy can reduce the risk of long-term microvascular complications. But patients’ vigilant monitoring of their daytime blood sugar, food intake, insulin and activity levels is perhaps less exhausting than the worries they face about getting a safe night’s sleep. The Diabetes Control and Complications Trial in type 1 diabetes (T1DM) unequivocally showed the benefits of good glycemic control in preventing the complications of diabetes. In nondiabetic subjects, hypoglycemia was associated with a brisk counterregulatory hormone response (plasma epinephrine 246 +/- 38 vs. This increased glycosylated hemoglobin occurred despite increased administration of insulin, expressed in units per kilogram daily, to these children (P < 0.05). Neither trait anxiety nor FOH related to reported symptoms, and FOH was not lower in parents with insulin pump therapy. Brussels: IDF, 2015. Of the participants, 73% overtreated their episodes. WRONG! 4%; P = 0.002). Incidence and trends of childhood type 1 diabetes worldwide 1990–1999. Accepted March 9, 2015. The VEGF response is not dependent on RAS activity and only weakly associated with preservation of cognitive function during hypoglycemia. and midnight. Available at: http://www.idf.org/diabetesatlas [Last accessed 15 April 2016],4 Osservatorio Epidemiologico Regionale – Regione Autonoma della Sardegna. Il registro del diabete di tipo 1 in età pediatrica in Sardegna. This research may guide the development of treatment regimens to enhance symptom recognition or to stabilize the neurochemical response to hypoglycemia to reduce the impact of glucodeprivation on cognitive function. International consensus and guidelines have underlined the relevance of multiple dose insulin therapy to obtain a near physiological glycosylated hemoglobin (HbA1c) that may prevent or slow the progression of chronic complications of T1D5 IDF. Global IDF/ISPAD guideline for diabetes in childhood and adolescence. Pediatr Diabetes 2014. Available at: http://www.idf.org/guideline-diabetes-childhood.
[Last access 30 March 2016]. The Diabetes Control and Complications Trial (DCCT) has demonstrated that intensive therapy delays microvascular complications in adolescents and adults and euglycemia has a great impact on the management of diabetes in the young6 Nathan DM, Bebu I, Braffett BH, et al. Diabetes Control and Complications Trial (DCCT) – Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group, Nathan DM, et al. Although the clinical problem of nocturnal hypoglycemia in T1DM is well recognized, less is known about the mechanisms responsible for awakening during episodes of nocturnal hypoglycemia, and their perturbation in T1DM. Diabetes 2016: published online 19 February 2016, doi: 10.2337/db15-1517. However, a stricter control of glycemic values also increases the risk of severe hypoglycemia7 Clarke W, Jones T, Rewers A, et al. Assessment and management of hypoglycemia in children and adolescents with diabetes.

Pediatr Diabetes 2008;9:165-74. Severe hypoglycemia is one of the most dangerous acute complications during insulin treatment in patients with T1D. For more information about Healthline’s partnership with Diabetes Mine, please click here. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes Care 2013;36:1384-95. Metabolic impairment is a basic aspect in diabetes and may have severe outcomes on multiple physiologic pathways; glycemic control has a relevant role in this metabolic change and it is a daily challenge due to a great variability of glycemic profile. The brain is a glucose-dependent tissue for development, growth and remodeling: inadequate glycemic control becomes a metabolic insult that may compromise long-term cognitive functions in children, especially when severe hypoglycemia, recurrent hypoglycemia or chronic hyperglycemia occur.

Although some data derives from cross-sectional observational epidemiological studies, minimizing glucose variability should be a major goal for therapy9 McNeilly AD, McCrimmon RJ. The Scylla and Charybdis of glucose control in childhood type 1 diabetes? Pediatr Diabetes 2015;16:235-41. Shaefer et al.10 Shaefer C, Hinnen D, Sadler C. Hypoglycemia and diabetes: increased need for awareness. Curr Med Res Opin 2016: published online 9 March 2016, doi: 10.1185/03007995.2016.1163255 have reviewed the relevant problem of hypoglycemia and awareness. They have underlined how a consistent definition of hypoglycemia is needed, and the lack of an unambiguous definition makes recognition very difficult and the risk of admission in critical health condition very high.

A recent observational study11 Conget I, Avila D, Gimenez M, et al. Impaired awareness of hypoglycaemia in subjects with type 1 diabetes. Results of an online survey in a diabetes web site. Endocrinol Nutr 2016;63:121-5 investigated the frequency of hypoglycemia unawareness via a questionnaire in a free website. 6. According to the questionnaire, 23.4% of patients with T1D had hypoglycemia unawareness, 15.3% uncertain awareness and 14.1% experienced at least one episode of severe hypoglycemia. Although hypoglycemia is a critical acute complication, severe episodes and unawareness are not associated with an increased risk of all-cause mortality or cardiovascular death in patients with T1D12 Sejling AS, Schouwenberg B, Faerch LH, et al.

Association between hypoglycaemia and impaired hypoglycaemia awareness and mortality in people with type 1 diabetes mellitus. Diabet Med 2016;33:77-83.

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