Aim of the work: Impaired Hypoglycemia Awareness (IHA) is associated with an increased risk of Severe Hypoglycemia (SH) in adults with diabetes but is less known in youth. The purpose of this study was to determine the prevalence of IHA and its clinical characteristics in a cohort of children and adolescents with type 1 diabetes.
Methods: This prospective observational study of two-month duration included all eligible subjects with type 1 diabetes attending our center, aged from 4 to 20 years. IHA was defined by a score ≥4 on the Gold scale. For the aim of this study, SH was defined as an event leading to loss of consciousness. SH were collected by reviewing the patients logbook and adjudicated by an endocrinologist. Quality of life (QoL) was determined by mean of the 3-level version of the EuroQol instrument.
Main results: On the 404 subjects included, 128 (31.7%) were diagnosed with IHA. Among these, 21% experienced at least one SH vs 11% of patients without IHA during the study period (P=0.009). Subjects with IHA were younger (median [IQR]) (12.9 [10.416.3] vs 14.2 [11.716.9] years; P=0.025), younger at diabetes diagnosis (6.2 [3.59.3] vs 8.0 [5.011.2] years; P=0.001), more often c-peptide negative (78 vs 67%; P=0.037) and female (57 vs 44%; P=0.014) than subjects without IHA. There were no differences in diabetes duration (5.3 [2.88.5] vs 6.2 [3.68.6] years), in HbA1c (7.6 [7.08.5] vs 7.7 [7.18.6] %) or in nocturnal occurrence of SH (8.7 vs 5.7%). Subjects who experienced at least one SH were 2.9 times more likely to exhibit IHA (P=0.008) and decreasing QoL was associated with an increased likelihood of IHA. Subjects with IHA performed more glucose controls (7.0 [4.010.0] vs 6.0 [4.08.5] per day; P=0.046).
Conclusions: A significant proportion of youth with type 1 diabetes have IHA. Screening for IHA should be an important part of routine diabetes care in children, as IAH is associated with SH.
21 Oct 2019
Belgian Endocrine Society