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Hypoglycemia, coma link in type 1 diabetes declined in past decade
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The association between low blood glucose levels and risk for severe hypoglycemia and hypoglycemic coma in children and adolescents with type 1 diabetes has decreased in the past decade, according to research published in PLOS Medicine.
“These findings reveal a substantial decrease since 1995 in the previously strong inverse association between low HbA1c levels and severe hypoglycemia and hypoglycemic coma in this cohort of young Germans and Austrians with type 1 diabetes,” the researchers wrote. “It should now be possible to reduce the risk of long-term diabetic complications in such patients through achievement of near-normal glycemic control without increasing patients’ risk of severe hypoglycemia.”
Beate Karges, MD, of RWTH Aachen University in Germany, and colleagues prospectively analyzed data from 37,539 patients with type 1 diabetes (mean age, 14.4 years) in Germany and Austria. Data were documented between 1995 and 2012.
The investigators used multivariable regression analysis to assess the associations between severe hypoglycemia, hypoglycemic coma and HbA1c levels.
Between 1995 and 2012, the RR for severe hypoglycemia dropped from 1.28 (95% CI, 1.19-1.37) to 1.05 (95% CI, 1-1.09) per 1% decrease in HbA1c. In the same time frame, RR for hypoglycemic coma decreased from 1.39 (95% CI, 1.23-1.56) to 1.01 (95% CI, 0.93-1.1).
These changes corresponded to a yearly risk reduction of 1.2% (95% CI, 0.6-1.7) in severe hypoglycemia and 1.9% (95% CI, 0.8-2.9) in hypoglycemic coma.
The risk for severe hypoglycemia and coma decreased most in patients with HbA1c levels of 6% to 6.9% (RR=0.96 and 0.9) and 7% to 7.9% (RR=0.96 and 0.89) each year, respectively. During the study, glucose monitoring frequency and the use of insulin analogs and insulin pumps increased (P<.001).
The study was not designed to examine the effects of treatment modalities on hypoglycemia risk, the researchers wrote. They noted that not addressing associations between diabetes education and physical activity and severe hypoglycemia was a limitation.
“These findings may apply only to young type 1 diabetes patients of European descent, and their accuracy may be limited by other aspects of the study design,” the researchers wrote. “However, by showing that HbA1c has become a minor predictor for severe hypoglycemia in this group of patients, these findings suggest that strict glycemic control in young patients with type 1 diabetes has become safer in recent years.”
Disclosure: This work was supported by the Competence Network for Diabetes Mellitus, the BMBF Federal Ministry of Education and Research, and the European Foundation for the Study of Diabetes.
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