Glycated hemoglobin A1c as a risk factor for severe hypoglycemia in pediatric type 1 diabetes: HbA1c and hypoglycemia risk

Karges, Beate; Kapellen, Thomas; Wagner, Verena M; Steigleder-Schweiger, Claudia; Karges, Wolfram; Holl, Reinhard W; Rosenbauer, Joachim; for the DPV Initiative

doi:10.1111/pedi.12348

Cited by 58Diabetes Management and ResearchDiabetes and associated disordersDiabetes Management and Education

Glycated hemoglobin A1c as a risk factor for severe hypoglycemia in pediatric type 1 diabetes: HbA1c and hypoglycemia risk

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Karges, Beate, Kapellen, Thomas, Wagner, Verena M, Steigleder-Schweiger, Claudia, Karges, Wolfram, Holl, Reinhard W, Rosenbauer, Joachim, for the DPV Initiative·2017·Pediatric Diabetes

DOI 10.1111/pedi.12348

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Abstract

OBJECTIVE: To assess the risk of severe hypoglycemia related to glycated hemoglobin A1c (HbA1c) levels in a population-based cohort of pediatric type 1 diabetes patients during two time periods since 1995. METHODS: The association between HbA1c levels and severe hypoglycemia (defined as requiring assistance from another person) or hypoglycemic coma (loss of consciousness or seizures) was analyzed by multivariable regression analysis in children and adolescents with type 1 diabetes from the DPV Diabetes Prospective Follow-up in Germany and Austria in 1995-2003 (n = 15 221 patients) and 2004-2012 (n = 22 318 patients). RESULTS: Mean adjusted rates of severe hypoglycemia and hypoglycemic coma decreased from 19.18 [95% confidence interval (CI), 17.95-20.48] and 4.36 (3.93-4.83) per 100 patient-years in 1995-2003 to 15.01 (14.18-15.88) and 2.15 (1.94-2.39) in 2004-2012, respectively (p < 0.001). From the first to the second period, the relative risk (RR) for severe hypoglycemia and hypoglycemic coma per 1% lower HbA1c decreased from 1.22 (1.15-1.30) to 1.06 (1.01-1.12) and from 1.27 (1.15-1.40) to 1.04 (0.94-1.16), respectively. Risk of severe hypoglycemia and coma declined most in patients with HbA1c levels of 6-6.9% (RR 0.70 and 0.43, respectively) and with HbA1c of 7-7.9% (RR 0.63 and 0.38, respectively). Mean HbA1c levels fell from 8.4% in 1995-2003 to 8.2% in 2004-2012, while the use of insulin pumps, short- and long-acting insulin analogs, and glucose monitoring increased (p < 0.001). CONCLUSIONS: In contrast to 1995-2003, low HbA1c has become a minor risk factor for severe hypoglycemia and coma in pediatric patients with type 1 diabetes in the 2004-2012 period.

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CGM and other advanced diabetes technologies allow HbA1c to reach target without raising severe hypoglycaemia risk.
“with CGM and other advanced diabetes technologies HbA1c can be lowered into the target range without increasing the risk of severe hypoglycaemia.114”
From Type 1 diabetes (2018) · cites this paper as [114]
The Discussion says that children and adolescents with type 1 diabetes may be able to achieve optimal HbA1c targets without increased severe hypoglycemia risk. It does not establish that CGM or other advanced technologies enable this: the authors explicitly say that which devices or treatment approaches contributed remains unresolved. Page numbers are unavailable in our copy. (LLM, conf=0.89)
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Authors: Karges, B., Kapellen, T., Wagner, V. M., Steigleder-Schweiger, C., Karges, W., Holl, R. W., Rosenbauer, J., & Initiative, F. T. D.
Affiliations: German Center for Diabetes Research (DE)
University Hospital Leipzig (DE)
University of Lübeck (DE)
Department of Pediatrics; Paracelsus Medical University Salzburg; Salzburg Austria
Division of Endocrinology and Diabetes, Medical Faculty; RWTH Aachen University, German Center for Diabetes Research (DZD); Aachen Germany
Universität Ulm (DE)
Deutsches Diabetes-Zentrum e.V. (DE)
Corresponding author: Karges, Beate
ORCID: Karges, Beate
Kapellen, Thomas
Holl, Reinhard W
Rosenbauer, Joachim
Venue: Pediatric Diabetes
Publisher: Wiley
Published: 2015-12-29
Volume: 18
Issue: 1
Pages: 51-58
ISSN: 1399-543X (ISSN-L)
DOI: 10.1111/pedi.12348
OpenAlex: W2215008771
Cited by: 58
References: 34
Citations by year: 2026: 1 · 2025: 3 · 2024: 5 · 2023: 6 · 2022: 5 · 2021: 5 · 2020: 6 · 2019: 7 · 2018: 9 · 2017: 8 · 2016: 3
FWCI: 5.78
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: doi.wiley.com/10.1002/tdm_license_1 (tdm)
onlinelibrary.wiley.com/termsAndConditions (vor)
Locations: Pediatric Diabetes (publishedVersion)
PubMed (publishedVersion)
RWTH Publications (RWTH Aachen) (submittedVersion)
Funders: Bundesministerium für Bildung und Forschung (FKZ 01GI1106, 01GI1109B)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords: HbA1c, severe hypoglycemia, hypoglycemic coma, type 1 diabetes in children, glycemic control, HbA1c trends, hypoglycemia risk factors, children and adolescents, diabetes complications, HbA1c thresholds
MeSH terms: Adolescent, Adult, Child, Child, Preschool, Diabetes Mellitus, Type 1, Diabetic Coma, Female, Glycated Hemoglobin, Humans, Hypoglycemia, Infant, Male, Risk Factors, Severity of Illness Index, Young Adult

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Glycated hemoglobin A1c as a risk factor for severe hypoglycemia in pediatric type 1 diabetes: HbA1c and hypoglycemia risk

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