medwireNews: Impaired hypoglycemia awareness (IHA) is present in a substantial proportion of children and young people with type 1 diabetes and is associated with an increased risk for severe hypoglycemia, suggests research presented at the virtual 57th EASD Annual Meeting.
“Frequent assessments of [IHA] may therefore help to improve management of the risk of hypoglycemia” in this population, said Anissa Messaaoui (Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium).
The study included 283 participants aged 6–20 years who used flash glucose monitoring for the management of type 1 diabetes. Messaaoui said that IHA, measured using the Gold method, was “highly prevalent” at baseline, with 47% of participants having a score of 3 or higher on a 7-point Likert scale adapted for pediatric use.
“It is interesting to note that despite the development of new technologies for measuring blood sugar levels, impaired hypoglycemia awareness still affects a large proportion of young people with type 1 diabetes,” she remarked.
In a multivariate analysis, the 134 participants with IHA at baseline had a significant 3.2-fold higher risk for severe hypoglycemia and a significant 2.1-fold higher risk for nocturnal severe hypoglycemia in the subsequent 2 months than the 149 without, at rates of 21% versus 8% and 10% versus 4%, respectively.
The researchers then evaluated IHA trajectories over 1 year, finding that 41% of the study population had the condition during follow-up. In accordance with the baseline results, IHA at 1 year was significantly associated with severe hypoglycemia and nocturnal severe hypoglycemia risk, “confirming that the risk of severe hypoglycemia associated with [IHA] is independent of the time of diagnosis,” reported Messaaoui.
The presenter also noted that a “high proportion” of participants changed IHA status over time. Specifically, 22% of participants without IHA at baseline were newly diagnosed during follow-up, whereas 39% of those with IHA at baseline reverted to normal hypoglycemia awareness.
Participants with changing IHA status had an average Gold score that was closer to the threshold for IHA (≥3) than those without, but “we were not able to identify any clear factors associated with this changing hypoglycemic awareness status,” said Messaaoui.
“Future studies have yet to evaluate the physiological mechanisms underlying the regaining of normal awareness in these young people,” she added.
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