Pôle PEDI, Institut de Recherche Expérimentale et Clinique, UCLouvain, 1200 Brussels, Belgium.
Specialized Pediatrics Service, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium.
Nutrients. 2023 Jun 29;15(13):2957. doi: 10.3390/nu15132957.
This study aims to evaluate the determinants and clinical markers of patients at risk for severe hypoglycemia (SH) in children and adolescents with type 1 diabetes. In the EPI-GLUREDIA study, clinical parameters and continuous glucose monitoring metrics from children and adolescents with type 1 diabetes were retrospectively analyzed between July 2017 and June 2022. Their clinical parameters were collected during traditional and quarterly medical consultations according to whether they experienced severe hypoglycemia or not. Then, continuous glucose monitoring metrics were analyzed on days surrounding SH during specific periods. According to the glycemic parameters, glycemic hemoglobin and glycemic mean were significantly lower in the three months preceding a SH compared with during three normal months ( < 0.05). Moreover, the time spent in hypoglycemia(time below the range, TBR) and its strong correlation (R = 0.9, < 0.001) with the frequency of SH represent a sensitive and specific clinical parameter to predict SH (cut-off: 9%, sensitivity: 71%, specificity: 63%). The second finding of the GLUREDIA study is that SH is not an isolated event in the glycemic follow-up of our T1DM patients. Indeed, most of the glycemic parameters (i.e., glycemic mean, glycemic variability, frequency of hypoglycemia, and glycemic targets) vary considerably in the month preceding an SH (all < 0.05), whereas most of these studied glycemic parameters remain stable in the absence of a severe acute complication (all > 0.05). Furthermore, the use of ROC curves allowed us to determine for each glycemic parameter a sensitive or specific threshold capable of more accurately predicting SH. For example, a 10% increase in the frequency of hypoglycemia predicts a risk of near SH with good combination of sensitivity and specificity (sensitivity: 80%, specificity: 60%). The GLUREDIA study aimed to target clinical and glycemic parameters to predict patients at risk for SH. First, we identified TBR < 9% as a sensitive and specific tool to reduce the frequency of SH. In addition, SH was not an isolated event but rather it was accompanied by glycemic disturbances in the 30 days before SH.
这项研究旨在评估 1 型糖尿病儿童和青少年发生严重低血糖 (SH) 风险的决定因素和临床标志物。在 EPI-GLUREDIA 研究中，回顾性分析了 2017 年 7 月至 2022 年 6 月期间患有 1 型糖尿病的儿童和青少年的临床参数和连续血糖监测指标。根据他们是否经历过严重低血糖，在传统和每季度医疗咨询期间收集他们的临床参数。然后，在特定时期，根据 SH 前后几天的连续血糖监测指标进行分析。根据血糖参数，与正常三个月相比，SH 前三个月的血糖血红蛋白和血糖平均值明显较低（<0.05）。此外，低血糖时间（低于范围的时间，TBR）及其与 SH 频率的强相关性（R=0.9，<0.001）是预测 SH 的敏感且特异的临床参数（截断值：9%，敏感性：71%，特异性：63%）。GLUREDIA 研究的第二个发现是，SH 不是我们 1 型糖尿病患者血糖随访中的孤立事件。事实上，大多数血糖参数（即血糖平均值、血糖变异性、低血糖频率和血糖目标）在前一个 SH 月变化较大（均<0.05），而在没有严重急性并发症的情况下，大多数这些研究的血糖参数保持稳定（均>0.05）。此外，ROC 曲线的使用使我们能够确定每个血糖参数的敏感或特异阈值，以更准确地预测 SH。例如，低血糖频率增加 10%可预测接近 SH 的风险，且具有良好的敏感性和特异性组合（敏感性：80%，特异性：60%）。GLUREDIA 研究旨在针对临床和血糖参数预测发生 SH 的风险患者。首先，我们确定 TBR<9%是一种敏感且特异的工具，可以降低 SH 的频率。此外，SH 不是孤立事件，而是伴随着 SH 前 30 天的血糖紊乱。
