Asymptomatic hypoglycaemia in Type 1 diabetes: incidence and risk factors

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

Aim: The epidemiology of asymptomatic (silent) hypoglycaemia is not well-described. We investigated incidence and risk factors for asymptomatic hypoglycaemia in Type 1 diabetes. Methods: A cohort of 153 people with Type 1 diabetes participated in 6 days of blinded continuous glucose monitoring (CGM) and recording of hypoglycaemia symptoms. At entry, hypoglycaemia awareness was classified (by three different methods) and HbA 1c and C-peptide were measured. Hypoglycaemic episodes were defined as interstitial glucose ≤ 3.9 mmol/l (IG 3.9 ) or ≤ 3.0 mmol/l (IG 3.0 ) for ≥ 15 min, and were considered asymptomatic if no hypoglycaemic symptoms were reported. Results: At thresholds IG 3.9 and IG 3.0 , the incidence rates of hypoglycaemic episodes were 5.0 (7.9) [median (IQR)] and 1.3 (3.4) episodes/person-week, respectively. Three-quarters of episodes were asymptomatic. In total, 77% and 52% of participants experienced one or more episode of asymptomatic hypoglycaemia at IG 3.9 and IG 3.0 [3.0 (6.2) and 1.0 (2.3) asymptomatic episodes/person-week]. At multivariate analysis, reduced awareness was positively associated with asymptomatic hypoglycaemia, particularly nocturnal events, and negatively with symptomatic hypoglycaemia. High insulin dose was associated with increased risk of both asymptomatic and symptomatic hypoglycaemia, whereas low HbA 1c and long diabetes duration were risk factors only for symptomatic hypoglycaemia. Conclusions: Asymptomatic hypoglycaemia constitutes the majority of hypoglycaemic events in Type 1 diabetes. Reduced hypoglycaemia awareness and high insulin dose are risk factors for asymptomatic hypoglycaemia but other conventional risk factors for severe hypoglycaemia do not correlate with risk of asymptomatic episodes.

OriginalsprogEngelsk
TidsskriftDiabetic Medicine
Vol/bind36
Udgave nummer1
Sider (fra-til)62-69
ISSN0742-3071
DOI
StatusUdgivet - 2019

ID: 223516002