Severe hypoglycemic episodes: A persistent threat for children with Type 1 diabetes mellitus and their families

Background: As lowering glycated hemoglobin (HbA(1c)) levels is still the main goal of insulin treatment, severe hypoglycemia (SH) remains a common experience in children with Type 1 diabetes mellitus (T1DM) and their families. Aim: This study aims to evaluate the incidence and the clinical features of SH episodes in our Centre in the last 20 yr. Subjects and Methods: We analyzed SH incidence in 269 patients (pts) diagnosed from 1990 to 2010 (total follow-up 2212.9 pts/yr). Inclusion criteria were at least 3 visits/yr and 1-yr follow-up. SH episode was defined as any condition of low blood glucose requiring third-party assistance. Results: 50.2% of patients experienced at least 1 SH episode for a total of 345 episodes. Whole incidence was 15.6/100 pts/yr, slightly different between first and second decade (12.6 vs 16.5, p=0.047). HbA(1c) at the time of SH was lower in the non-basal bolus group (7.4+/-1.3 vs 8.2+/-1.4; p=0.0001) and worsened 3 months later (p=0.0001). Impaired awareness was the main or only symptom in 43.5%. SH occurred at night in 32% of patients; they were significantly younger than those with SH at other times. Five SH episodes or more occurred in 8.1% of patients who presented a lower HbA(1c), a younger age and shorter disease duration than the other patients. HbA(1c) at first SH was negatively correlated with number of SH (r=-0.20; p=0.05). Conclusions: Despite the advent of new insulin regimens, we confirm that SH still represents a relevant risk and a current threat for patients with T1DM and their families. (C) 2013, Editrice Kurtis