1. Asymptomatic hypoglycaemia in Type 1 diabetes: incidence and risk factors.
- Author
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Henriksen, M. M., Andersen, H. U., Thorsteinsson, B., and Pedersen‐Bjergaard, U.
- Subjects
HYPOGLYCEMIA ,BLOOD sugar monitoring ,C-peptide ,GLYCOSYLATED hemoglobin ,INSULIN ,TYPE 1 diabetes ,LONGITUDINAL method ,MULTIVARIATE analysis ,DISEASE incidence ,SEVERITY of illness index ,DISEASE duration ,DISEASE complications ,DISEASE risk factors - Abstract
Aim: The epidemiology of asymptomatic (silent) hypoglycaemia is not well‐described. We investigated incidence and risk factors for asymptomatic hypoglycaemia in Type 1 diabetes. Methods: A cohort of 153 people with Type 1 diabetes participated in 6 days of blinded continuous glucose monitoring (CGM) and recording of hypoglycaemia symptoms. At entry, hypoglycaemia awareness was classified (by three different methods) and HbA1c and C‐peptide were measured. Hypoglycaemic episodes were defined as interstitial glucose ≤ 3.9 mmol/l (IG3.9) or ≤ 3.0 mmol/l (IG3.0) for ≥ 15 min, and were considered asymptomatic if no hypoglycaemic symptoms were reported. Results: At thresholds IG3.9 and IG3.0, the incidence rates of hypoglycaemic episodes were 5.0 (7.9) [median (IQR)] and 1.3 (3.4) episodes/person‐week, respectively. Three‐quarters of episodes were asymptomatic. In total, 77% and 52% of participants experienced one or more episode of asymptomatic hypoglycaemia at IG3.9 and IG3.0 [3.0 (6.2) and 1.0 (2.3) asymptomatic episodes/person‐week]. At multivariate analysis, reduced awareness was positively associated with asymptomatic hypoglycaemia, particularly nocturnal events, and negatively with symptomatic hypoglycaemia. High insulin dose was associated with increased risk of both asymptomatic and symptomatic hypoglycaemia, whereas low HbA1c and long diabetes duration were risk factors only for symptomatic hypoglycaemia. Conclusions: Asymptomatic hypoglycaemia constitutes the majority of hypoglycaemic events in Type 1 diabetes. Reduced hypoglycaemia awareness and high insulin dose are risk factors for asymptomatic hypoglycaemia but other conventional risk factors for severe hypoglycaemia do not correlate with risk of asymptomatic episodes. What's new?: The existence of asymptomatic hypoglycaemia in Type 1 diabetes has been described previously but the epidemiology of these episodes has not been explored, thus rates of asymptomatic hypoglycaemia are unclear.This study reveals that asymptomatic hypoglycaemia constitutes the majority of hypoglycaemic episodes in Type 1 diabetes assessed by blinded CGM.Highlighting that self‐reported symptomatic hypoglycaemia comprises only a minor fraction of the total burden of hypoglycaemia in Type 1 diabetes; particularly, in individuals with impaired hypoglycaemia awareness.This study highlights the importance of the use of CGM in detecting asymptomatic episodes; particularly in individuals with impaired hypoglycaemia awareness. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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