Predictors
of Acute Complications in Children With Type 1 Diabetes
Study determines the
factors that predict the incidence of ketoacidosis and severe
hypoglycemia in children.
Diabetic ketoacidosis and
severe hypoglycemia are acute complications of type 1 diabetes that
are related, respectively, to insufficient or excessive insulin
treatment. However, little is known about additional modifiable risk
factors.
The
Objective was to examine the incidence of ketoacidosis and
severe hypoglycemia in children with diabetes and t determine the
factors that predict these complications.
A
cohort of 1243 children from infancy to age 19 years with type 1
diabetes were followed up prospectively for 3994 person-years from
January 1, 1996, through December 31, 2000.
Main
Outcome Measures were Incidence of ketoacidosis leading to
hospital admission or emergency department visit and severe
hypoglycemia (loss of consciousness, seizure, or hospital admission or
emergency department visit).
The
Results showed the incidence of ketoacidosis was 8 per 100
person-years and increased with age in girls. In multivariate
analyses, sex-adjusted and stratified by age, the risk of ketoacidosis
in younger children increased with higher hemoglobin A1c
(HbA1c) and higher reported insulin dose . In older children, the
risk of ketoacidosis increased with higher HbA1c and
higher reported insulin dose. The incidence of severe
hypoglycemia was 19 per 100 person-years and decreased with age in girls.
In younger children, the risk of severe hypoglycemia increased
with diabetes duration. In older children, the risk of severe
hypoglycemia increased with duration, lower HbA1c, and
presence of psychiatric disorders. Eighty percent of episodes occurred
among the 20% of children who had recurrent events.
The
Study reached the conclusions that some children with diabetes remain
at high risk for ketoacidosis and severe hypoglycemia. Age- and
sex-specific incidence patterns suggest that ketoacidosis is a
challenge in adolescent girls while severe hypoglycemia continues to
affect disproportionally the youngest patients and boys of all ages.
The pattern of modifiable risk factors indicates that underinsured
children and those with psychiatric disorders or at the extremes of
the HbA1c distribution should be targeted for specific
interventions. JAMA.
2002;287:2511-2518
