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Severe hypoglycaemia, metabolic control and diabetes management in children with type 1 diabetes in the decade after the Diabetes Control and Complications Trial – a large-scale multicentre study

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Abstract

Hypoglycaemia is frequently the limiting factor in achieving optimal glycaemic control. Therefore, insulin therapy, the incidence of hypoglycaemia, and glycaemic control were investigated in 6309 unselected children with type 1 diabetes in a large-scale multicentre study. Using standardised computer-based documentation, the incidence of severe hypoglycaemia, HbA1 c levels, insulin regimen, diabetes duration, and the number of patients attending a treatment centre were investigated for the age groups 0-<5 years ( n =782), 5-<7 years ( n =1053), and 7-<9 years ( n =4474). The average HbA1 c level was 7.6% (no significant difference between age groups). Young children had more severe hypoglycaemic events (31.2/100 patient years) as compared to older children (19.7; 21.7/100 patient years, P <0.05) independent of the treatment regimen. Our data suggest that diabetes centres treating less than 50 patients per year have a higher incidence of hypoglycaemia in 0-<5-year-old children (43.0/100 patient years) as compared to larger centres (24.1/100 patient years; P <0.0001). Significant predictors of hypoglycaemia were younger age ( P <0.0001), longer diabetes duration ( P <0.0001), higher insulin dose/kg per day ( P <0.0001), injection regimen ( P <0.0005), and centre experience ( P <0.05). Conclusion:Despite modern treatment, young children have an elevated risk for developing severe hypoglycaemia compared to older children, especially when treated at smaller diabetes centres. The therapeutic goal of carefully regulating metabolic control without developing hypoglycaemia has still not been achieved. Further advances in diabetic treatment may result from giving more attention to hypoglycaemia in young children.

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Abbreviations

DCCT :

diabetes control and complications trial

py :

patient year

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Acknowledgements

This work was supported by grants from the German Ministry of Health, the German Diabetes Foundation, the German Diabetes Association, the Dr. Buerger-Buesing Foundation and Novo Nordisk Pharma GmbH.

We are grateful to the following paediatric departments that contributed data to this study: Kinderklinik, RWT, Aachen; St. Franziskus Kinderklinik Ahlen; Helios Kinderklinik Aue; Kinderklinik Augsburg; Kinderklinik Aurich; Kinderklinik Bad Hersfeld; Diabetesfachklinik Bad Oeynhausen; Kinderklinik Lindenhof Berlin; Virchow-Kinderklinik Berlin; Kinderklinik Gilead Bielefeld Universitäts-Kinderklinik Bonn; Kinderklinik Bottrop; Kinderklinik Nord Bremen; Kinderklinik St. Jürgenstrasse Bremen; Kinderklinik Bremerhaven; Kinderklinik Celle; Kinderklinik Chemnitz; Kinderklinik Coesfeld; Kinderklinik Prinzessin Margareth Darmstadt; Kinderklinik Datteln; Kinderarztpraxis Deggendorf; Kinderklinik Deggendorf; Kinderklinik Delmenhorst; Universitäts-Kinderklinik Dortmund; Universitäts-Kinderklinik Dresden; Kinderklinik Düren-Birkesdorf; Universitäts-Kinderklinik Düsseldorf; Kinderklinik Erfurt; Universitäts-Kinderklinik Erlangen; Universitäts-Kinderklinik Essen; Städtische Kinderklinik Esslingen; Kinderklinik Eutin; Universitäts-Kinderklinik Freiburg; Kinderklinik Friedrichshafen; Kinderklinik Fulda; Kinderklinik Fürth; Kinder-Fachklinik Gaissach; Kinderklinik Garmisch-Partenkirchen; Kinderklinik Gelsenkirchen; Universitäts-Kinderklinik Giessen; Kinderklinik am Eichert Göppingen; Städtische Kinderklinik Görlitz; Universitäts-Kinderklinik Göttingen; DRK-Klinik Westerwald Innere Hackenburg; Kinderklinik Hagen; Universitäts-Kinderklinik Halle; Städtisches Krankenhaus Halle-Dölau; Altonaer Kinderklinik Hamburg; Wilhelmsstift Hamburg Kinderklinik; Kinderklinik Heidberg Hamburg-Nord; Kinderklinik Hamm; Kinderklinik Hanau; Kinderklinik MHH Hannover; Universitäts-Kinderklinik Heidelberg; Kinderklinik Heidenheim; Kinderklinik Herford; Kinderklinik Hildesheim; Kinderarztpraxis Hildesheim; Diabetiker-Jugendhaus Hinrichsegen-Bruckmühl; Universitäts-Kinderklinik Homburg Saarland; Kinderklinik Itzehoe; Universitäts-Kinderklinik Jena; Kinderklinik Westpfalzklinikum Kaiserslautern; Diabetesfachklinik Karlsburg; Städtische Kinderklinik Karlsruhe; Kinderklinik Park Schönfeld Kassel; Städtische Kinderklinik Kassel; Städtische Kinderklinik Kiel; Kinderklinik Kemperhof Koblenz; Universitäts-Kinderklinik Köln; Kinderklinik Landshut; Universitäts-Kinderklinik Leipzig; Kinderklinik St. Bonifazius Lingen; Evangelische Kinderklinik Lippstadt; Kinderklinik Ludwigsburg; Kinderklinik St. Annastift Ludwigshafen; Universitäts-Kinderklinik Lübeck; Kinderklinik Lüdenscheid; Universitäts-Kinderklinik Magdeburg; Universitäts-Kinderklinik Mannheim; Universitäts-Kinderklinik Marburg; Kinderklinik Mechernich; Kinderklinik Minden; Kinderklinik Moers; Kinderklinik Rheydt Elisabethkrankenhaus Mönchengladbach; Kinderarztpraxis Mutterstadt; von Haunersche Kinderklinik München; Kinderklinik München-Harlaching; Kinderarztpraxis Münster; Universitäts-Kinderklinik Münster; Kinderklinik Kohlhof Neukirchen; Kinderklinik Elisabeth Neuwied; Cnopfsche Kinderklinik Nürnberg; Kinderklinik Süd Nürnberg; Kinderklinik Oberhausen; Kinderklinik Offenbach/Main; Kinderklinik Oldenburg; Kinderklinik Osnabrück; St. Vincenz Kinderklinik Paderborn; Kinderklinik Pforzheim; Kinderklinik St. Nikolaus Ravensburg; Kinderklinik St. Hedwig Regensburg; Kinderklinik Remscheidt; Kinderklinik Rendsburg; Kinderklinik Rosenheim; Kinderklinik Rotenburg/Wümme; Kinderklinik Thüringenklinik Saalfeld; Kinderklinik Winterberg Saarbrücken; Margaritenhospital Kinderklinik Schwäbisch Gmünd; Kinderklinik Siegen; Hegauklinik Kinderklinik Singen; Kinderklinik Stade; Kinderklinik Olgahospital Stuttgart; Kinderklinik Suhl; Rehaklinik Sylt; Kinderklinik der Borromäerinnen Trier; Universitäts-Kinderklinik Ulm; Kinderklinik Viersen; Kinderklinik Waiblingen; Kinderarztpraxis Biberbau Waldshut; Kinderklinik Weiden; Kinderklinik Weingarten; Universitäts-Kinderklinik Wien; Horst-Schmidt-Kinderklinik Wiesbaden; Kinderklinik DKD Wiesbaden; Universitäts-Kinderklinik Witten-Herdecke; Kinderklinik Worms and Kinderklinik Wuppertal.

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Authors and Affiliations

  1. Department of Paediatrics, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 , Lübeck, Germany

    Verena M. Wagner

  2. Department of Applied Information Technology, University of Ulm, Ulm, Germany

    Matthias Grabert

  3. Department of Biomedical Engineering, University of Ulm, Ulm, Germany

    Reinhard W. Holl

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  1. Verena M. Wagner
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  2. Matthias Grabert
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  3. Reinhard W. Holl
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Correspondence to Verena M. Wagner.

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On behalf of the German Initiative on Quality Control in Paediatric Diabetology.

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Wagner, V.M., Grabert, M. & Holl, R.W. Severe hypoglycaemia, metabolic control and diabetes management in children with type 1 diabetes in the decade after the Diabetes Control and Complications Trial – a large-scale multicentre study. Eur J Pediatr 164, 73–79 (2005). https://doi.org/10.1007/s00431-004-1560-4

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