Impaired Hypoglycemia Awareness in Children and Adolescents with Type 1 Diabetes and its Association with Diabetic Autonomic Neuropathy.

Background: In general, hypoglycemia is more frequent among the young explaining the higher frequency of impaired awareness of hypoglycemia (IAH) among children and adolescents. Thus the aim of the current study was to assess the frequency of IAH among an Egyptian cohort of children and adolescents with type 1 diabetes and identify the possible association between impaired awareness of hypoglycemia and autonomic neuropathy. Patients and Methods: A cross sectional study recruiting 100 patients with type 1 diabetes for at least 6 months duration and aged less than 18 years old recruited from the Pediatric and Adolescent Diabetes Unit (PADU). Patients with other form of diabetes, cardiac disease, thyroid disease, anemia, other chronic disease, patients with intellectual disabilities or patients taking any medications were excluded from the study. The Gold and Clarke questionnaires were used to assess hypoglycemia awareness among the studied cohort. Cardiac autonomic neuropathy (CAN) was assessed using 15 minutes Holterelectrocardiography (ECG). Results: Among the studied cohort, 42% showed IAH using the Clarke's and Gold's Questionnaires. When assessing CAN, 46% of the studied cohort showed resting tachycardia and patients with resting tachycardia showed significantly longer disease duration. There were no normative heart rate variability parameters values for the Egyptian children that can be used as a reference for diagnosis of cardiac autonomic neuropathy. So we used sex and age matched control group to find specific cutoff values for heart rate variability parameters to diagnose CAN. The results showed that the prevalence of CAN among studied- patients was 88% and there were no significant correlation between CAN and both questionnaires score. 55.7% of CAN patients were aware while 44.3% were unaware. Thus, there were no association between impaired awareness of hypoglycemia and CAN. The results showed that there was significant positive correlation between cardiac autonomic neuropathy (CAN) and diabetic duration more than 5 years. Conclusion: Although there were no association between impaired awareness of hypoglycemia and cardiac autonomic neuropathy, it is important to screen for CAN in patients with IAH, especially that CAN is usually asymptomatic among children with type 1 diabetes. [ABSTRACT FROM AUTHOR]