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Hypoglycemia prevalence in prepubertal children with type 1 diabetes on standard insulin regimen: Use of continuous glucose monitoring system

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Amin, Rakesh, Ross, Karen, Acerini, Carlo L., Edge, Julie A., Warner, Justin, Dunger, David B.·2003·Diabetes Care
DOI 10.2337/diacare.26.3.662
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Abstract

OBJECTIVE: To determine hypoglycemia prevalence in prepubertal children on thrice (TID) and twice (BID) daily insulin regimens, using the Medtronic Minimed Continuous Glucose Monitoring System. RESEARCH DESIGN AND METHODS: Twenty-eight children aged <12 years (median 9.8, range 6.9-11.8) wore the sensor for three consecutive days and nights. Hypoglycemia was defined as glucose <60 mg/dl for >15 min. Data are expressed as the percentage of time period spent hypoglycemic. RESULTS: Hypoglycemia prevalence was 10.1% (mean 2.6 h. subject(-1) x day(-1)). Hypoglycemia was more common at night compared with daytime (18.81 vs. 4.4%, P < 0.001); 78 and 43% of subjects showed hypoglycemia on at least one night and two or more nights, respectively. Nocturnal episodes were prolonged (median 3.3 h) and asymptomatic (91% of episodes). Prevalence was greater between 0400 and 0730 h than between 2200 and 0400 h (25.5 vs. 15.4%, P < 0.001). On a TID compared with a BID regimen, nocturnal hypoglycemia prevalence was reduced, particularly between 0400-0730 h (22.9 vs. 27.4%, P = 0.005), whereas hypoglycemia the following morning (0730-1200 h) was greater (7.8 vs. 2.8%, P < 0.001). Nocturnal hypoglycemia risk was associated with decreasing age (by a factor of 0.6 for a year less in age), increased insulin dose (by 1.6 for an increase of 0.1 units. kg(-1) x day(-1)), insulin regimen (by 0.2 on a BID compared with a TID regimen), and increased weight standard deviation score (SDS) (by 2.7 for a one SDS rise). CONCLUSIONS: Use of standard insulin regimens results in high prevalence and large intraindividual variation in hypoglycemia, particularly at night. Independent risk factors for nocturnal hypoglycemia were younger age, greater daily insulin dose, insulin regimen, and increasing weight.

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  • Around 60-70% of nocturnal hypoglycemic episodes in patients with diabetes occur during late sleep, i.e., between 03:00 and 07:00 h.

    “Around 60–70% of nocturnal hypoglycemic episodes in patients with diabetes occur during late sleep, i.e., between 03:00 and 07:00 h [ 35 , 36 ].”

    From Hypoglycemia Unawareness—A Review on Pathophysiology and Clinical Implications (2024) · cites this paper as [36]

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Authors
Amin, R., Ross, K., Acerini, C. L., Edge, J. A., Warner, J., & Dunger, D. B.
Affiliations
  • Addenbrooke's Hospital (GB)
  • John Radcliffe Hospital (GB)
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2003-03-01
Volume
26
Issue
3
Pages
662-667
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/diacare.26.3.662
OpenAlex
W2171347197
Cited by
106
References
36
Citations by year
2026: 1 · 2024: 6 · 2023: 1 · 2021: 2 · 2020: 3 · 2019: 3 · 2018: 1 · 2017: 1 · 2016: 2 · 2015: 4 · 2014: 9 · 2013: 5 · 2012: 7
FWCI
6.51
Type
journal article
Language
en
Open access
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Funders
  • American Diabetes Association
  • Novo Nordisk
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
type 1 diabetes, prepubertal children, nocturnal hypoglycemia, continuous glucose monitoring, insulin regimens, twice-daily insulin, insulin dose, body weight, age, asymptomatic hypoglycemia, hypoglycemia risk factors, time in hypoglycemia, within-person variability
MeSH terms
Child, Diabetes Mellitus, Type 1, Female, Glycated Hemoglobin, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin, Male, Risk Factors, Blood Glucose Self-Monitoring, Cohort Studies, Prevalence, Logistic Models

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