Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; Children's Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
Division of Paediatric and Adolescence Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Oslo Diabetes Research Centre, Oslo University Hospital, Oslo, Norway.
Diabetes Res Clin Pract. 2024 Mar;209:111093. doi: 10.1016/j.diabres.2024.111093. Epub 2024 Jan 13.
To determine the prevalence and associations of impaired awareness of hypoglycemia (IAH) in pediatric type 1 diabetes.
Nationwide, population-based cross-sectional study with 51 % participation. Participants (n = 1329; 53 % males) aged 2-19 years (median 13.3) with type 1 diabetes ≥ 6 months (median 4.6 years) self-assessed hypoglycemia awareness with a validated questionnaire ('Clarke'). Parents responded for children aged < 9 years (n = 235). We estimated associations between IAH and clinical data in the Norwegian Childhood Diabetes Registry.
The overall prevalence of IAH was 22 %, but gradually decreased from 53 % in preschoolers to 12 % in adolescents aged ≥ 16 years. IAH was associated (adjusted OR; 95 %CI) with episodes of severe hypoglycemia (6.0; 3.04, 11.8) and diabetic ketoacidosis (3.45; 1.37, 8.68) the preceding year, increased fear of hypoglycemia (highest quartile vs. lowest: 2.27; 1.51, 3.40), female sex (1.41; 1.05, 1.90), and HbA1c ≥ 8.5 % (69 mmol/mol) vs. 7.5-8.4 % (58-68 mmol/mol) (1.48; 1.01, 2.18), but not with disease duration, use of insulin pump or continuous glucose monitoring, or HbA1c < 7.5 % (58 mmol/mol).
IAH is prevalent in pediatric diabetes and more likely reported in young children. IAH is associated with severe hypoglycemia and fear of hypoglycemia, but good metabolic control seems achievable without increased risk of IAH.
确定儿科 1 型糖尿病患者中低血糖意识受损（IAH）的患病率及其相关因素。
这是一项全国范围内、基于人群的横断面研究，参与率为 51%。参与者（n=1329；男性占 53%）年龄为 2-19 岁（中位数为 13.3 岁），患有 1 型糖尿病≥6 个月（中位数为 4.6 年），使用经过验证的问卷（“Clarke”）自我评估低血糖意识。对于年龄<9 岁的儿童（n=235），由其父母进行回答。我们估计了 IAH 与挪威儿童糖尿病登记处临床数据之间的关联。
IAH 的总体患病率为 22%，但逐渐从学龄前儿童的 53%下降到 16 岁以上青少年的 12%。IAH 与前一年严重低血糖发作（6.0；3.04，11.8）和糖尿病酮症酸中毒（3.45；1.37，8.68）相关，与低血糖恐惧增加相关（最高四分位与最低四分位相比：2.27；1.51，3.40），与女性（1.41；1.05，1.90）相关，与 HbA1c≥8.5%（69mmol/mol）相比，HbA1c 为 7.5-8.4%（58-68mmol/mol）（1.48；1.01，2.18）相关，但与病程、胰岛素泵或连续血糖监测的使用或 HbA1c<7.5%（58mmol/mol）无关。
IAH 在儿科糖尿病中较为普遍，并且在年幼的儿童中更常见。IAH 与严重低血糖和低血糖恐惧相关，但在没有增加 IAH 风险的情况下，似乎可以实现良好的代谢控制。
