Frequency of severe hypoglycemia in insulin-dependent diabetes mellitus can be predicted from self-monitoring blood glucose data.

Cox, D J; Kovatchev, B P; Julian, D M; Gonder-Frederick, L A; Polonsky, W H; Schlundt, D G; Clarke, W L

doi:10.1210/jcem.79.6.7989471

Cited by 137Diabetes Management and ResearchDiabetes Management and EducationDiabetes Treatment and Management

Frequency of severe hypoglycemia in insulin-dependent diabetes mellitus can be predicted from self-monitoring blood glucose data.

Cox, D J, Kovatchev, B P, Julian, D M, Gonder-Frederick, L A, Polonsky, W H, Schlundt, D G, Clarke, W L·1994·The Journal of Clinical Endocrinology & Metabolism

DOI 10.1210/jcem.79.6.7989471

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Abstract

Severe hypoglycemia is associated with insulin-dependent diabetes mellitus and may occur more frequently as metabolic control approaches normal. The goal of this study was to determine whether the frequency of severe hypoglycemia could be predicted by the following predictor variables: 1) frequency and degree of low blood glucose (BG) readings, 2) degree of BG variability during routine self-monitoring blood glucose (SMBG) readings, and 3) level of glycemic control measured by glycosylated hemoglobin-A1 (HbA1). Seventy-eight insulin-dependent diabetes mellitus subjects from 3 different sites had their glycosylated HbA1 assayed and then performed 50 SMBG recordings during the next 2-3 weeks. Over the following 6 months, subjects recorded their severe hypoglycemic episodes (stupor or unconsciousness). There was no difference in the number of severe hypoglycemic episodes between subjects in good vs. poor metabolic control. A higher frequency of severe hypoglycemia during the subsequent 6 months was predicted by frequent and extreme low SMBG readings and variability in day to day SMBG readings. Regression analysis indicated that 44% of the variance in severe hypoglycemic episodes could be accounted for by initial measures of BG variance and the extent of low BG readings. Patients who recorded variable and frequent very low BG readings during routine SMBG were at higher risk for subsequent severe hypoglycemia. Individuals who had lower glycosylated Hb levels were not at higher risk of severe hypoglycemic episodes.

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A1C fails to identify the magnitude and frequency of intra- and inter-day glucose variation.
“A1C also fails to identify the magnitude and frequency of intra- and inter-day glucose variation (34; 35).”
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Authors: Cox, D. J., Kovatchev, B. P., Julian, D. M., Gonder-Frederick, L. A., Polonsky, W. H., Schlundt, D. G., & Clarke, W. L.
Affiliations: University of Virginia (US)
ORCID: Cox, D J
Kovatchev, B P
Gonder-Frederick, L A
Polonsky, W H
Schlundt, D G
Venue: The Journal of Clinical Endocrinology & Metabolism
Publisher: The Endocrine Society
Published: 1994-12
Volume: 79
Issue: 6
Pages: 1659-1662
ISSN: 0021-972X (ISSN-L)
1945-7197
DOI: 10.1210/jcem.79.6.7989471
OpenAlex: W2101481281
Cited by: 137
References: 12
Citations by year: 2024: 3 · 2023: 4 · 2022: 10 · 2021: 5 · 2020: 7 · 2019: 8 · 2018: 10 · 2017: 7 · 2016: 3 · 2015: 11 · 2014: 6 · 2013: 6 · 2012: 4
FWCI: 1.17
Type: journal article
Language: en
Open access: closed
Locations: The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (5r01dk028288-27)
National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK28288)
National Center for Research Resources (M01RR000847, M01-RR 00847)
NIH Clinical Center
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords: severe hypoglycemia, type 1 diabetes, self-monitoring of blood glucose, blood glucose variability, HbA1c, glycemic control, hypoglycemia risk prediction
MeSH terms: Adult, Blood Glucose, Diabetes Mellitus, Type 1, Female, Glycated Hemoglobin, Humans, Hypoglycemia, Male, Regression Analysis, Risk Factors, Blood Glucose Self-Monitoring

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Frequency of severe hypoglycemia in insulin-dependent diabetes mellitus can be predicted from self-monitoring blood glucose data.

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