Fredheim S, Johansen A, Thorsen S U, Kremke B, Nielsen L B, Olsen B S, Lyngsøe L, Sildorf S M, Pipper C, Mortensen H B, Johannesen J, Svensson J
Department of Pediatrics, Herlev Hospital, Arkaden, Turkisvej 14, 2730, Herlev, Copenhagen, Denmark,
Acta Diabetol. 2015 Jun;52(3):591-9. doi: 10.1007/s00592-014-0697-5. Epub 2014 Dec 21.
To examine contemporary rates of severe hypoglycemia (SH) and identify the effect of predictors of SH in a pediatric type 1 diabetes population.
The national diabetes register provided data on children residing in Denmark from 2008 to 2013 in this register-based population study. Robust Poisson regression models were applied.
The study population [n = 2,715 (50.9 % boys), mean (SD) age at onset; 8.1 (4.0) years, diabetes duration; 5.6 (4.9) years] comprised 7,390 person-years of data and 561 events of SH. The overall incidence of SH was 7.6 per 100 person-years. The incidence rate peaked with 16.0 per 100 person-years in 2008 reaching a nadir of 4.9 in 2011. Overall, insulin pump reduced the rate of SH with 27 % compared to any pen treatment (P = 0.003). When stratifying pen treatment, premixed insulin increased the rate of SH by 1.9-fold (P = 0.0015) and NPH increased the rate by 1.6-fold (P = 0.003) versus pump treatment, whereas long-acting insulin analogues were comparable with pump treatment (P = 0.1485). We found no association of SH with glycemic control (P > 0.05).
A nationwide halving in rates of severe hypoglycemia was observed during the study period independent of the prevailing average HbA1c level. Changes in diabetes care and successful educational programs may have influenced the lower incidence rate of severe hypoglycemia.
研究当代儿童1型糖尿病患者严重低血糖（SH）的发生率，并确定SH预测因素的影响。
在这项基于登记处的人群研究中，国家糖尿病登记处提供了2008年至2013年居住在丹麦儿童的数据。应用稳健泊松回归模型。
研究人群[n = 2715（50.9%为男孩），发病时平均（标准差）年龄；8.1（4.0）岁，糖尿病病程；5.6（4.9）年]包含7390人年的数据和561例SH事件。SH的总体发生率为每100人年7.6例。发生率在2008年达到峰值，为每100人年16.0例，在2011年降至最低点，为每100人年4.9例。总体而言，与任何笔式胰岛素治疗相比，胰岛素泵使SH发生率降低了27%（P = 0.003）。在对笔式胰岛素治疗进行分层时，与胰岛素泵治疗相比，预混胰岛素使SH发生率增加了1.9倍（P = 0.0015），NPH使发生率增加了1.6倍（P = 0.003），而长效胰岛素类似物与胰岛素泵治疗相当（P = 0.1485）。我们发现SH与血糖控制无关（P > 0.05）。
在研究期间，全国范围内严重低血糖发生率减半，且与当时的平均糖化血红蛋白水平无关。糖尿病护理的改变和成功的教育项目可能影响了严重低血糖较低的发生率。
