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Dysglycemia among youth with type 1 diabetes and suboptimal glycemic control in the Flexible Lifestyle Empowering Change trial
Author(s) -
Kahkoska Anna R.,
Crandell Jamie,
Driscoll Kimberly A.,
Kichler Jessica C.,
Seid Michael,
MayerDavis Elizabeth J.,
Maahs David M.
Publication year - 2019
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/pedi.12805
Subject(s) - hypoglycemia , medicine , glycemic , diabetes mellitus , type 1 diabetes , type 2 diabetes , logistic regression , incidence (geometry) , pediatrics , endocrinology , physics , optics
Objective To examine the prevalence and correlates of non‐severe hypoglycemia among adolescents with type 1 diabetes and suboptimal glycemic control, an understudied topic in this group. Methods Seven days of blinded continuous glucose monitor data were analyzed in 233 adolescents at baseline of the Flexible Lifestyle Empowering Change trial (13‐16 years, type 1 diabetes duration >1 year, and hemoglobin A1c [HbA1c] 8‐13% [64‐119 mmol]). Incidence of clinical hypoglycemia (54‐69 mg/dL) and clinically serious hypoglycemia (<54 mg/dL) was defined as number of episodes ≥15 minutes. Logistic regression modeling was used to determine the correlates of long duration of hypoglycemia, categorized by median split among those who experienced hypoglycemia. Results The sample was 76.1% non‐Hispanic white, 49.8% female, age = 14.9 ± 1.1 years, diabetes duration = 6.4 ± 3.7 years, and HbA1c = 9.6 ± 1.2% (81 ± 13 mmol/mol). Over 7 days, 79.4% of youth experienced ≥1 hypoglycemic episodes of <70 mg/dL, and 55.4% of youth experienced ≥1 hypoglycemic episodes of <54 mg/dL. Among all adolescents, the median duration of clinical hypoglycemia and clinically serious hypoglycemia was 21.9 (range 0‐250.2) and 4.3 (range 0‐209.7) minutes/day, respectively. Long duration of clinical hypoglycemia (range 1.8‐17.4% time overall) and clinically serious hypoglycemia (range 1.2‐14.6% time overall) was associated with older age and decreasing HbA1c. Long duration of clinically serious hypoglycemia also was associated with insulin pump use. Conclusions Almost 80% of adolescents with elevated HbA1c had an episode of clinical hypoglycemia, and >50% had clinically serious hypoglycemia in a week. Increased education alongside access to emerging diabetes technologies may help to prevent hypoglycemia while improving glycemic control.