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ARS Home » Plains Area » Houston, Texas » Children's Nutrition Research Center » Research » Publications at this Location » Publication #299779
Title: Severe hypoglycemia and diabetic ketoacidosis among youth with type 1 diabetes in the T1D Exchange clinic registry

Author
item CENGIZ, EDA - Yale University
item XING, DONGYUAN - Jaeb Center For Health Research
item WONG, JENISE - University Of California
item WOLFSDORF, JOSEPH - Boston Children'S Hospital
item HAYMOND, MOREY - Children'S Nutrition Research Center (CNRC)
item REWERS, ARLETA - University Of Colorado
item SHANMUGHAM, SATYA - Stanford University
item TAMBORLANE, WILLIAM - Yale University
item WILLI, STEVEN - The Children'S Hospital Of Philadelphia
item SEIPLE, DIANE - Central Ohio Pediatrics Endocrinology And Diabetes Services (COPEDS)
item MILLER, KELLEE - Jaeb Center For Health Research
item DUBOSE, STEPHANIE - Jaeb Center For Health Research
item BECK, ROY - Jaeb Center For Health Research

Submitted to: Pediatric Diabetes
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/1/2013
Publication Date: 9/1/2013
Citation: Cengiz, E., Xing, D., Wong, J.C., Wolfsdorf, J.I., Haymond, M.W., Rewers, A., Shanmugham, S., Tamborlane, W.V., Willi, S.M., Seiple, D.L., Miller, K.M., Dubose, S.N., Beck, R.W. 2013. Severe hypoglycemia and diabetic ketoacidosis among youth with type 1 diabetes in the T1D Exchange clinic registry. Pediatric Diabetes. 14(6):447-454.

Interpretive Summary: Severe low blood sugar (resulting in coma, seizure or inability to correct the low sugar on their own) and severe high blood sugars (associated with dehydration and the accumulation of breakdown products of fat metabolism [diabetic ketoacidosis]) are common serious and life threatening acute complications of individuals suffering from type 1 diabetes (insulin requiring diabetes). The aim of this study was to determine the frequency of both of these conditions and identify factors related to their occurrence in the T1D Exchange pediatric and young adult cohort. The analysis included 13,487 participants in the T1D Exchange clinic registry who were between the ages of 2 and 25 years and having the diagnosis of diabetes for 2 years or more. Statistical methods were used to evaluate the association of baseline demographic and clinical factors with the occurrence of severe low glucose or diabetic ketoacidosis in the prior 12 months. Individuals who were non-White race, had no private health insurance, and had lower household income had higher frequencies of both severe low blood sugars and diabetic ketoacidosis. Our data show that poor blood sugar control increases the risk of diabetic ketoacidosis but does not protect against severe low blood sugars in youth and young adults with type 1 diabetes. The high frequencies of these two complications of type 1 diabetes observed in disadvantaged minorities with type 1 diabetes highlight the need for targeted interventions and new treatment paradigms for individuals in these high risk groups.

Technical Abstract: Severe hypoglycemia (SH) and diabetic ketoacidosis (DKA) are common serious acute complications of type 1 diabetes (T1D). The aim of this study was to determine the frequency of SH and DKA and identify factors related to their occurrence in the T1D Exchange pediatric and young adult cohort. The analysis included 13,487 participants in the T1D Exchange clinic registry aged 2 to <26 yr with T1D >=2 yr. Separate logistic regression models were used to evaluate the association of baseline demographic and clinical factors with the occurrence of SH or DKA in the prior 12 months. Non-white race, no private health insurance, and lower household income were associated with higher frequencies of both SH and DKA (p<0.001). SH frequency was highest in children <6 yr old (p=0.005), but across the age range, SH was not associated with hemoglobin A1c (HbA1c) levels after controlling for other factors (p=0.72). DKA frequency was highest in adolescents (p<0.001) and associated with higher HbA1c (p<0.001). Our data show that poor glycemic control increases the risk of DKA but does not protect against SH in youth and young adults with type 1 diabetes. The high frequencies of SH and DKA observed in disadvantaged minorities with T1D highlight the need for targeted interventions and new treatment paradigms for patients in these high risk groups.