Increasing incidence of hypoglycemic coma in children with IDDM.
OBJECTIVE
To examine the incidence of hypoglycemic coma in children with insulin-dependent diabetes mellitus (IDDM) over 8 yr from 1981 to 1988 and to investigate the importance of residual beta-cell function of HbA1 levels and other variables as risk factors for hypoglycemic coma.


METHODS
The study consisted of 155 children with IDDM aged less than 16 yr at study entry. Mean age at onset of diabetes was 7.9 yr (range 1.1-15.6 yr). We made a prospective assessment of hypoglycemic coma episodes, with a standardized questionnaire, over a total observation time of 816.6 person-yr. Three monthly clinical and laboratory examinations, which included determinations of C-peptide and HbA1 levels, were conducted. We compared children with hypoglycemic coma (cases) with children without hypoglycemic coma (controls) in a case-control analysis matched for diabetes duration. Yearly incidence of hypoglycemic coma, calculated as the number of subjects having an attack in 1 yr divided by the cumulative number of person-years for that year, was measured. Univariate and multivariate odds ratios were calculated from logistic regression.


RESULTS
Over the first 4 yr, the average yearly incidence was 4.4/100 person-yr compared with 7.4/100 person-yr during the later 4 yr (P less than 0.0001). This tendency was accompanied by intensification of insulin treatment with an increase in the mean number of daily injections and a decrease in mean HbA1 levels. In the case-control analysis, absent residual beta-cell function was the most important risk factor for hypoglycemic coma (adjusted odds ratio 7.8, 95% confidence intervals 2.0-31.2), followed by near-normal HbA1 levels (adjusted odds ratio 4.5, 95% confidence intervals 1.9-10.5).


CONCLUSIONS
In this group of children, improvement of glycemic control apparently led to an increase in the incidence of severe hypoglycemia. In children with recurrent hypoglycemic coma and undetectable C-peptide levels, it may be safer to aim for somewhat less tight glycemic control.
Egger
M
M
Department of Pediatrics, University of Berne, Switzerland.
Gschwend
S
S
Smith
G D
GD
Zuppinger
K
K
D000293:Adolescent; D000818:Animals; D015415:Biomarkers / Q000097:blood; D002096:C-Peptide / Q000097:blood; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D015994:Incidence; D007328:Insulin / Q000009:adverse effects* / Q000627:therapeutic use; D007330:Insulin Antibodies / Q000032:analysis; D007331:Insulin Coma / Q000453:epidemiology*; D008297:Male; D016017:Odds Ratio; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D012044:Regression Analysis; D012307:Risk Factors; D013552:Swine; D013557:Switzerland
D015415:Biomarkers; D002096:C-Peptide; D006442:Glycated Hemoglobin; D007328:Insulin; D007330:Insulin Antibodies; D011994:Recombinant Proteins