Objectives: To evaluate the ability of a group of children and adolescent with T1DM to recognize the state of hypoglycemia and to estimate their hypoglycemic symptomatic threshold (HST). To identify risk factors for the development of severe hypoglycemia. Methods: Forty-five T1DM patients (22 Males) aged 15.1 (5.3) were asked to complete a questionnaire designed to investigate the HST, the type of neuroglycopenic and autonomic symptoms and the frequency of moderate and severe hypoglycemic episodes.The patients were then asked for a three months period to measure and record blood glucose (BG) levels and any hypoglycemic symptom at least four time a day (before and two hours after main meals). HbA1c, Insulin requirement, mean and SD of BG values, low BG (LBGI) and high BG (HBGI) indexes were taken into account.The results are reported as median (IQR). Mann–Whitney, Kruskal– Wallis and simple regression were used for statistical analysis. Results: Forty-five patients completed the questionnaire and 14 (31%) of them reported the three months glucose and hypoglycemic symptoms monitoring. The reported HST was 69 mg/dl in 28/45 (62%), 50 mg/dl in 14/45(31%) and 40 mg/dl in 3/45(7%).The patients reporting the lowest HST showed significant higher LBGI (p < 0.05). The rate of hypoglycemic values in HBGM in the previous six months was 7.7% (7.4). The percentage of hypoglycemic values resulted directly related to disease duration (p < 0.05), age (p < 0.02), LBGI (p < 0.002). Four patients (10%) who reported a HST of 69 mg/dl and who declared to be always able to recognize hypoglycemic symptoms, showed, during the previous year, at least one episode of severe hypoglycemia. The patients who showed severe hypoglycemic events have significantly higher BG SD in the last six months (p < 0.002). Conclusions: In our experience, BG-SD is a predictive parameter of severe hypoglycemic events, while LBGI, HST and prevalence of LBG values do not appear to be reliable risk indicators.
Symptomatic threshold of hypoglycemia and predictors of severe hypoglycemia in children and adolescent with T1DM
COSTANTINI, CHIARA;CARDANI, ROBERTA;BIANCHI, GIULIANA;MUSOLINO, GIANLUCA;SALVATONI, ALESSANDRO
2015-01-01
Abstract
Objectives: To evaluate the ability of a group of children and adolescent with T1DM to recognize the state of hypoglycemia and to estimate their hypoglycemic symptomatic threshold (HST). To identify risk factors for the development of severe hypoglycemia. Methods: Forty-five T1DM patients (22 Males) aged 15.1 (5.3) were asked to complete a questionnaire designed to investigate the HST, the type of neuroglycopenic and autonomic symptoms and the frequency of moderate and severe hypoglycemic episodes.The patients were then asked for a three months period to measure and record blood glucose (BG) levels and any hypoglycemic symptom at least four time a day (before and two hours after main meals). HbA1c, Insulin requirement, mean and SD of BG values, low BG (LBGI) and high BG (HBGI) indexes were taken into account.The results are reported as median (IQR). Mann–Whitney, Kruskal– Wallis and simple regression were used for statistical analysis. Results: Forty-five patients completed the questionnaire and 14 (31%) of them reported the three months glucose and hypoglycemic symptoms monitoring. The reported HST was 69 mg/dl in 28/45 (62%), 50 mg/dl in 14/45(31%) and 40 mg/dl in 3/45(7%).The patients reporting the lowest HST showed significant higher LBGI (p < 0.05). The rate of hypoglycemic values in HBGM in the previous six months was 7.7% (7.4). The percentage of hypoglycemic values resulted directly related to disease duration (p < 0.05), age (p < 0.02), LBGI (p < 0.002). Four patients (10%) who reported a HST of 69 mg/dl and who declared to be always able to recognize hypoglycemic symptoms, showed, during the previous year, at least one episode of severe hypoglycemia. The patients who showed severe hypoglycemic events have significantly higher BG SD in the last six months (p < 0.002). Conclusions: In our experience, BG-SD is a predictive parameter of severe hypoglycemic events, while LBGI, HST and prevalence of LBG values do not appear to be reliable risk indicators.
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