Contemporary rates of severe hypoglycaemia in youth with Type 1 diabetes: variability by insulin regimen
Article first published online: 19 JUN 2012
© 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK
Volume 29, Issue 7, pages 926–932, July 2012
How to Cite
Katz, M. L., Volkening, L. K., Anderson, B. J. and Laffel, L. M. (2012), Contemporary rates of severe hypoglycaemia in youth with Type 1 diabetes: variability by insulin regimen. Diabetic Medicine, 29: 926–932. doi: 10.1111/j.1464-5491.2012.03646.x
- Issue published online: 19 JUN 2012
- Article first published online: 19 JUN 2012
- Accepted manuscript online: 14 MAR 2012 01:10PM EST
- Accepted 8 March 2012
- insulin therapy;
- Type 1 diabetes
Diabet. Med. 29, 926–932 (2012)
Aims To determine incidence rates of severe hypoglycaemia and compare incidence rates by insulin regimen in a diverse sample of youth with Type 1 diabetes from two sites.
Methods In this observational study, 255 youth (51% female) aged 9–15 years receiving varied insulin regimens provided data prospectively for a median of 1.2 years. Reported episodes of severe hypoglycaemia, defined as episodes requiring help from another person for oral treatment or episodes resulting in seizure/coma, and current insulin regimens were collected systematically. Incidence rates were calculated and compared according to insulin regimen in bivariate and multivariate analyses.
Results At first encounter, participants had a median age of 12.2 years (range 9.0–15.0), median diabetes duration of 4.4 years (range 1.0–13.0) and mean HbA1c of 67 ± 12 mmol/mol (8.3 ± 1.1%). The incidence rate was 37.6/100 patient-years for all severe hypoglycaemia and 9.6/100 patient-years for seizure/coma. The incidence rate for severe hypoglycaemia was 31.8/100 patient-years on continuous subcutaneous insulin infusion (pump therapy), 34.4/100 patient-years on basal–bolus injections and 46.1/100 patient-years on NPH (NPH vs. pump therapy: P = 0.04). The incidence rate for seizure/coma was 4.5/100 patient-years on pump therapy, 11.1/100 patient-years on basal–bolus injections and 14.4/100 patients-years on NPH (NPH vs. pump therapy: P = 0.004). In the multivariate analysis, the rate of seizure/coma was significantly higher for those on NPH vs. pump therapy (rate ratio 2.9, P = 0.03).
Conclusions Rates of severe hypoglycaemia in youth with Type 1 diabetes remain high. Pump therapy was associated with lower rates of all severe hypoglycaemia and seizure/coma in comparison with NPH.