Affiliation:
1. Preventive Medicine and
2. Medicine, University of Wisconsin Medical School, Madison, Wisconsin
Abstract
OBJECTIVE—To determine the risk of frequent and severe hypoglycemia and the associated demographic and clinical risk factors.
RESEARCH DESIGN AND METHODS—Demographic and diabetes self-management factors were measured in 415 subjects followed prospectively for 4–6.5 years of type 1 diabetes duration as participants in a population-based incident cohort. Blood samples were collected up to three times yearly to test glycosylated hemoglobin (GHb) levels. Reports of frequent (2–4 times/week) and severe (lost consciousness) hypoglycemia as well as other diabetes self-management data were collected by questionnaires.
RESULTS—Frequent hypoglycemia was common (33 and 35% of participants reported this on the 4- and 6.5-year questionnaires, respectively), whereas severe hypoglycemia occurred much less often. Better glycemic control (odds ratio [OR] 1.3 per 2% decrease in GHb, 95% CI 1.1–1.5) and more frequent self-monitored blood glucose (1.5 per blood glucose check, 1.3–1.7) were independently related to frequent hypoglycemia. The association of frequent hypoglycemia with intensive insulin therapy increased with age. Better glycemic control (1.5 per 2% decrease in GHb, 1.2–2.0) and older age were related to severe hypoglycemic reactions. No sociodemographic factors other than age increased the risk of hypoglycemia.
CONCLUSIONS—Frequent hypoglycemia was common in a population representing the full range of glycemic control in the community. Intensive insulin management and blood glucose monitoring independently predicted frequent but not severe hypoglycemia. This information may be useful for updating patients such that minor changes in diabetes management might decrease the daily burden of this condition while maintaining intensive insulin therapy.
Publisher
American Diabetes Association
Subject
Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine
Reference22 articles.
1. Cryer PE, Binder C, Bolli GB, Cherrington AD, Gale JE, Sherwin RS: Conference summary: hypoglycemia in IDDM. Diabetes 38:1193–1199, 1989
2. Wredling R, Levander S, Adamson UL, Wredling R, Levander S, Adamson U, Lins PE: Permanent neuropsychological impairment after recurrent episodes of severe hypoglycaemia in man. Diabetologia 33:152–157, 1990
3. Cryer PE, Gerich JE: Hypoglycemia in insulin dependent diabetes mellitus: insulin excess and defective glucose counterregulation. In Diabetes Mellitus Theory and Practice. 4th ed. Rifkin H, Porte D Jr, Eds. New York, Elsevier, 1990, p. 526–527
4. The Diabetes Control and Complications Trial Research Group: The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329:977–986, 1993
5. Bell DSH, Cutter G: Characteristics of severe hypoglycemia in the patient with insulin-dependent diabetes. South Med J 87:616–620, 1994
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