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Nationwide reduction in the frequency of severe hypoglycemia by half

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Abstract

Aims

To examine contemporary rates of severe hypoglycemia (SH) and identify the effect of predictors of SH in a pediatric type 1 diabetes population.

Methods

The national diabetes register provided data on children residing in Denmark from 2008 to 2013 in this register-based population study. Robust Poisson regression models were applied.

Results

The study population [n = 2,715 (50.9 % boys), mean (SD) age at onset; 8.1 (4.0) years, diabetes duration; 5.6 (4.9) years] comprised 7,390 person-years of data and 561 events of SH. The overall incidence of SH was 7.6 per 100 person-years. The incidence rate peaked with 16.0 per 100 person-years in 2008 reaching a nadir of 4.9 in 2011. Overall, insulin pump reduced the rate of SH with 27 % compared to any pen treatment (P = 0.003). When stratifying pen treatment, premixed insulin increased the rate of SH by 1.9-fold (P = 0.0015) and NPH increased the rate by 1.6-fold (P = 0.003) versus pump treatment, whereas long-acting insulin analogues were comparable with pump treatment (P = 0.1485). We found no association of SH with glycemic control (P > 0.05).

Conclusions

A nationwide halving in rates of severe hypoglycemia was observed during the study period independent of the prevailing average HbA1c level. Changes in diabetes care and successful educational programs may have influenced the lower incidence rate of severe hypoglycemia.

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Abbreviations

CSII:

Continuous subcutaneous insulin infusion

DANDIABKIDS:

Danish National Diabetes Register in Childhood and Adolescence

DCCT:

Diabetes control and complications trial

HbA1c:

Glycated hemoglobin HbA1c

IFCC:

International Federation of Clinical Chemistry

NPH:

Neutral protamine Hagedorn

RCT:

Randomized control trial

SH:

Severe hypoglycemia

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Acknowledgments

We are grateful to patients and their families, and our colleagues throughout the country who provided us with patient data. We acknowledge our bioanalyst Jette Høgsmose for expert handling of blood samples and data management. This work was supported by “Beckett Foundation,” “Dr. Louise’s Children Hospitals Research Grant,” and the Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

Conflict of interest

JS has received lecture funding from Novo Nordisk, Sanofi Aventis and is part of the Bayer Advisory Board. SMS and JS are stock/shareholders in Novo Nordisk. All other authors declare no conflict of interest.

Ethical standard

The study was performed according to the criteria of the Helsinki II Declaration and was approved by the local ethics committee.

Human and animal rights disclosure

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Informed consent disclosure

Informed consent for participation in register studies is not required according to Danish law.

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Correspondence to S. Fredheim.

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Managed by Massimo Porta.

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Fredheim, S., Johansen, A., Thorsen, S.U. et al. Nationwide reduction in the frequency of severe hypoglycemia by half. Acta Diabetol 52, 591–599 (2015). https://doi.org/10.1007/s00592-014-0697-5

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  • DOI: https://doi.org/10.1007/s00592-014-0697-5

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