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Cited by 243Diabetes Management and ResearchDiabetes Management and EducationDiabetes and associated disorders

Severe hypoglycemia and diabetic ketoacidosis among youth with type 1 diabetes in the T1D Exchange clinic registry: SH and DKA in patients with T1D

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Cengiz, Eda, Xing, Dongyuan, Wong, Jenise C., Wolfsdorf, Joseph I., Haymond, Morey W., Rewers, Arleta, Shanmugham, Satya, Tamborlane, William V. +6 more·2013·Pediatric Diabetes
DOI 10.1111/pedi.12030PMC PMC4100244
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Abstract

OBJECTIVE: Severe hypoglycemia (SH) and diabetic ketoacidosis (DKA) are common serious acute complications of type 1 diabetes (T1D). The aim of this study was to determine the frequency of SH and DKA and identify factors related to their occurrence in the T1D Exchange pediatric and young adult cohort. RESEARCH DESIGN AND METHODS: The analysis included 13 487 participants in the T1D Exchange clinic registry aged 2 to <26 yr with T1D ≥2 yr. Separate logistic regression models were used to evaluate the association of baseline demographic and clinical factors with the occurrence of SH or DKA in the prior 12 months. RESULTS: Non-White race, no private health insurance, and lower household income were associated with higher frequencies of both SH and DKA (p < 0.001). SH frequency was highest in children <6 yr old (p = 0.005), but across the age range, SH was not associated with hemoglobin A1c (HbA1c) levels after controlling for other factors (p = 0.72). DKA frequency was highest in adolescents (p < 0.001) and associated with higher HbA1c (p < 0.001). CONCLUSIONS: Our data show that poor glycemic control increases the risk of DKA but does not protect against SH in youth and young adults with type 1 diabetes. The high frequencies of SH and DKA observed in disadvantaged minorities with T1D highlight the need for targeted interventions and new treatment paradigms for patients in these high risk groups.

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  • The rate of severe hypoglycaemia needing help from another person is 16-20 per 100 person-years.

    “Severe hypoglycaemic events requiring treatment assistance from another person occur at rates of 16–20 per 100 person-years;”

    From Type 1 diabetes (2018) · cites this paper as [103]

    The Results (Severe Hypoglycemia; page unavailable) report that 6.2% of participants had at least one event in 12 months, not a rate of 16–20 events per 100 person-years. The Discussion explicitly says the study counted events involving seizure or loss of consciousness, rather than events merely requiring another person's assistance, and did not report an event rate. (LLM, conf=0.88)

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  • Hypoglycaemic events leading to loss of consciousness or seizure occur at 2-8 per 100 person-years.

    “hypoglycaemic events leading to loss of consciousness or seizure occur at a rate of 2–8 per 100 person-years.103–105”

    From Type 1 diabetes (2018) · cites this paper as [103]

    The Results (Severe Hypoglycemia; page unavailable) report that 6.2% of participants had at least one event involving seizure or loss of consciousness within 12 months. The Discussion explicitly distinguishes that percentage of participants from a rate measured as events per 100 person-years. The source therefore supports the event type and a broadly similar annual frequency, but not the claimed rate of 2–8 events per 100 person-years. (LLM, conf=0.88)

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  • This study should be interpreted in relation to international rates of DKA in children with T1D, which are higher than in Sweden.

    “This study should be interpreted in relation to international rates of DKA in children with T1D, which are higher than in Sweden. 34 , 35”

    From Insulin pump therapy is associated with higher rates of mild diabetic ketoacidosis compared to injection therapy: A 2‐year Swedish national survey of children and adolescents with type 1 diabetes (2022) · cites this paper as [34]

    The Results > DKA section reports that 9.9% of participants in a US registry had at least one DKA event within 12 months. The Discussion places that figure alongside rates from other studies but says those rates are difficult to compare; it gives no Swedish rate or comparison showing that international rates are higher than Sweden’s. (LLM, conf=0.81)

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Research works printed but not linked: 1

  1. [12]The Diabetes Control and Complications Trial Research Group Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Complications Trial. J Pediatr 1994 125 177 88 8040759

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Authors
Cengiz, E., Xing, D., Wong, J. C., Wolfsdorf, J. I., Haymond, M. W., Rewers, A., Shanmugham, S., Tamborlane, W. V., Willi, S. M., Seiple, D. L., Miller, K. M., DuBose, S. N., Beck, R. W., & for the T1D Exchange Clinic Network
Affiliations
  • Yale University (US)
  • Jaeb Center for Health Research (US)
  • University of California, San Francisco (US)
  • Boston Children's Hospital (US)
  • Baylor College of Medicine (US)
  • University of Colorado Anschutz (US)
  • Stanford Medicine (US)
  • Children's Hospital of Philadelphia (US)
  • Central Ohio Pediatrics Endocrinology and Diabetes Services; Columbus; OH; USA
Corresponding author
Xing, Dongyuan
ORCID
Venue
Pediatric Diabetes
Publisher
Wiley
Published
2013-03-08
Volume
14
Issue
6
Pages
447-454
ISSN
1399-543X (ISSN-L)
DOI
10.1111/pedi.12030
PMC
PMC4100244
OpenAlex
W1927920927
Cited by
243
References
17
Citations by year
2026: 5 · 2025: 8 · 2024: 16 · 2023: 17 · 2022: 23 · 2021: 30 · 2020: 20 · 2019: 31 · 2018: 23 · 2017: 11 · 2016: 16 · 2015: 20 · 2014: 19 · 2013: 3 · 2012: 1
FWCI
15.24
Type
journal article
Language
en
Open access
Licence
doi.wiley.com/10.1002/tdm_license_1.1 (tdm, 907 d)
Locations
  • Pediatric Diabetes (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • National Institutes of Health (5k12dk094726-05, 5t32dk007161-48, UL1TR000439)
  • National Institute of Diabetes and Digestive and Kidney Diseases (T32-DK-007161, K12-DK094726)
  • National Center for Research Resources (UL1RR024139)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
Keywords
severe hypoglycemia, diabetic ketoacidosis, type 1 diabetes, youth, young adults, T1D Exchange, glycemic control, HbA1c, socioeconomic disparities, racial disparities, health insurance, household income
MeSH terms
Adolescent, Adult, Child, Child Development, Child, Preschool, Diabetes Mellitus, Type 1, Glycated Hemoglobin, Humans, Hyperglycemia, Hypoglycemia, Hypoglycemic Agents, Registries, Risk, Severity of Illness Index, United States, Cohort Studies, Logistic Models, Diabetic Ketoacidosis, Adolescent Development, Young Adult

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