Hypoglycemia prevalence in prepubertal children with type 1 diabetes on standard insulin regimen: Use of continuous glucose monitoring system

被引:65
作者
Amin, R
Ross, K
Acerini, CL
Edge, JA
Warner, J
Dunger, DB
机构
[1] Univ Cambridge, Addenbrookes Hosp, Dept Paediat, Cambridge CB2 2QQ, England
[2] John Radcliffe Hosp, Oxford OX3 9DU, England
关键词
D O I
10.2337/diacare.26.3.662
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVE - To determine hypoglycemia prevalence in prepubertal children on thrice (TID) and twice (BID) daily insulin regimens, using the Medtronic Minimed Continuous Glucose Monitoring System. RESEARCH DESIGN AND METHODS - Twenty-eight children aged <12 years (median 9.8, range 6.9-11.8) wore the sensor for three consecutive days and nights. Hypoglycemia was defined as glucose <60 mg/dl for >15 min. Data are expressed as the percentage of time period spent hypoglycemic. RESULTS - Hypoglycemia prevalence was 10.1% (mean 2.6 h.subject(-1).day(-1)). Hypoglycemia was more common at night compared with daytime (18.81 vs. 4.4%, P < 0.001); 78 and 43% of subjects showed hypoglycemia on at least one night and two or moire nights, respectively. Nocturnal episodes were prolonged (median 3.3 h) and asymptomatic (91% of episodes). Prevalence was greater between 0400 and 0730 h than between 2200 and 0400 h (25.5 vs. 15.4%, P < 0.001). On a TID compared with a BID regimen, nocturnal hypoglycemia. prevalence was reduced, particularly between 0400-0730 h (22.9 vs. 27.4%, P = 0.005), whereas hypoglycemia the following morning (0730-1200 h) was greater (7.8 vs. 2.8%, P < 0.001). Nocturnal hypoglycemia risk was associated with decreasing age (by a factor of 0.6 for a year less in age), increased insulin dose (by 1.6 for an increase of 0.1 units.kg(-1).day(-1)) insulin regimen (by 0.2 on a BID compared with a TID regimen), and increased weight standard deviation score (SDS) (by 2.7 for a one SDS rise). CONCLUSIONS - Use of standard insulin regimens results in high prevalence and large intraindividual variation in hypoglycemia, particularly at night. Independent risk factors for nocturnal hypoglycemia were younger age, greater daily insulin dose, insulin regimen, and increasing weight.
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页码:662 / 667
页数:6
相关论文
共 37 条
[1]   SYMPTOMATIC HYPOGLYCEMIA IN CHILDHOOD DIABETES - A POPULATION-BASED QUESTIONNAIRE STUDY [J].
AMAN, J ;
KARLSSON, I ;
WRANNE, L .
DIABETIC MEDICINE, 1989, 6 (03) :257-261
[2]   SEVERE HYPOGLYCEMIA IN IDDM CHILDREN [J].
BERGADA, I ;
SUISSA, S ;
DUFRESNE, J ;
SCHIFFRIN, A .
DIABETES CARE, 1989, 12 (04) :239-244
[3]   INSULIN PHARMACOKINETICS [J].
BINDER, C ;
LAURITZEN, T ;
FABER, O ;
PRAMMING, S .
DIABETES CARE, 1984, 7 (02) :188-199
[4]  
Bjorgaas M, 1996, ACTA NEUROL SCAND, V93, P398
[5]   STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT [J].
BLAND, JM ;
ALTMAN, DG .
LANCET, 1986, 1 (8476) :307-310
[6]   Limitations of conventional methods of self-monitoring of blood glucose - Lessons learned from 3 days of continuous glucose sensing in pediatric patients with type 1 diabetes [J].
Boland, E ;
Monsod, T ;
Delucia, M ;
Brandt, CA ;
Fernando, S ;
Tamborlane, WV .
DIABETES CARE, 2001, 24 (11) :1858-1862
[7]   Continuous subcutaneous insulin infusion - A new way to lower risk of severe hypoglycemia, improve metabolic control, and enhance coping in adolescents with type 1 diabetes [J].
Boland, EA ;
Grey, M ;
Oesterle, A ;
Fredrickson, L ;
Tamborlane, WV .
DIABETES CARE, 1999, 22 (11) :1779-1784
[8]   Continuous subcutaneous glucose monitoring in children with type 1 diabetes [J].
Chase, HP ;
Kim, LM ;
Owen, SL ;
MacKenzie, TA ;
Klingensmith, GJ ;
Murtfeldt, R ;
Garg, SK .
PEDIATRICS, 2001, 107 (02) :222-226
[9]  
COLE TJ, 1990, EUR J CLIN NUTR, V44, P45
[10]   FACTORS AFFECTING GLYCOSYLATED HEMOGLOBIN VALUES IN CHILDREN WITH INSULIN-DEPENDENT DIABETES [J].
DANEMAN, D ;
WOLFSON, DH ;
BECKER, DJ ;
DRASH, AL .
JOURNAL OF PEDIATRICS, 1981, 99 (06) :847-853