Department of Endocrinology, Yale University, New Haven, CT, USA.
Pediatr Diabetes. 2013 Sep;14(6):447-54. doi: 10.1111/pedi.12030. Epub 2013 Mar 8.
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.
严重低血糖（SH）和糖尿病酮症酸中毒（DKA）是 1 型糖尿病（T1D）常见的严重急性并发症。本研究旨在确定 SH 和 DKA 的频率，并确定与 T1D Exchange 儿科和青年队列中其发生相关的因素。
该分析包括 T1D Exchange 临床登记处年龄在 2 至<26 岁、T1D 持续时间≥2 年的 13487 名参与者。分别使用逻辑回归模型评估基线人口统计学和临床因素与 12 个月内 SH 或 DKA 发生的相关性。
非白种人、没有私人医疗保险和较低的家庭收入与 SH 和 DKA 的发生频率较高相关（p<0.001）。SH 的频率在<6 岁的儿童中最高（p=0.005），但在整个年龄范围内，在控制其他因素后，SH 与血红蛋白 A1c（HbA1c）水平无关（p=0.72）。DKA 的频率在青少年中最高（p<0.001），与较高的 HbA1c 相关（p<0.001）。
我们的数据表明，较差的血糖控制会增加 DKA 的风险，但不能保护青少年和年轻的 T1D 患者免受 SH 的影响。在 T1D 处于不利地位的少数民族中观察到的 SH 和 DKA 的高频率突出表明需要针对这些高风险群体的患者进行有针对性的干预和新的治疗模式。
