Risk Factors for Frequent and Severe Hypoglycemia in Type 1 Diabetes

• Published in: Diabetes care Vol. 24; no. 11; pp. 1878 - 1881
• Main Authors: ALLEN, Catherine, LECAIRE, Tamara, PALTA, Mari, DANIELS, Kathleen, MEREDITH, Melissa, D'ALESSIO, Donn J
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01-11-2001
• Subjects: Adolescent; Adult; Age Factors; Biological and medical sciences; Child; Child, Preschool; Cohort Studies; Complications and side effects; Demographics; Demography; Diabetes; Diabetes Mellitus, Type 1 - blood; Drug toxicity and drugs side effects treatment; Educational Status; Evaluation; Female; Humans; Hypoglycemia; Hypoglycemia - epidemiology; Infant; Insurance, Health - statistics & numerical data; Male; Medical sciences; Miscellaneous (drug allergy, mutagens, teratogens...); Occupations; Odds Ratio; Pharmacology. Drug treatments; Risk Factors; Self Care; Self-care, Health; Socioeconomic Factors; Surveys and Questionnaires; Type 1 diabetes; Wisconsin; Wisconsin; United States; Endocrinopathy; Human; Immunopathology; Hypoglycemic agent; Demography; Toxicity; Risk factor; Insulin dependent diabetes; Autoimmune disease; Hypoglycemia; Insulin; Age
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/diacare.24.11.1878

Risk Factors for Frequent and Severe Hypoglycemia in Type 1 Diabetes
Catherine Allen , PHD 1 ,
Tamara LeCaire , MS 1 ,
Mari Palta , PHD 1 ,
Kathleen Daniels , MS 1 ,
Melissa Meredith , MD 2 ,
Donn J. D’Alessio , MD 1 and
for the Wisconsin Diabetes Registry Project
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.
DCCT, Diabetes Control and Complications Trial
GHb, glycosylated hemoglobin
OR, odds ratio
SMBG, self-monitored blood glucose
Footnotes
Address correspondence and reprint requests to Catherine Allen, PhD, University of Wisconsin Medical School, Department of
Preventive Medicine, 610 N. Walnut St., Room 6601, Madison, WI 53705. E-mail: ciallen{at}facstaff.wisc.edu .
Received for publication 30 January 2001 and accepted in revised form 20 July 2001.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.