Nocturnal hypoglycemia in children and adolescents with insulin-dependent diabetes mellitus: prevalence and risk factors.
OBJECTIVE
To evaluate the prevalence and risk factors of nocturnal hypoglycemia (NH) in children and adolescents with insulin-dependent diabetes mellitus.


METHODS
A total of 150 patients, 87% of whom were receiving conventional therapy, were admitted to the hospital for one night. Blood glucose (BG) levels were measured hourly from 10 PM to 8 AM.


RESULTS
The prevalence of NH was 47%; NH was asymptomatic in 49% of the cases. Risk factors were as follows: at least two episodes of severe hypoglycemia from onset of insulin-dependent diabetes mellitus (p = 0.0004), insulin dosage > 0.85 IU/kg per day (p = 0.02), more than 5% of BG measurements < or = 3.3 mmol/L during the last month of monitoring (p = 0.04). The risk decreased significantly with age (p = 0.0001). Both high predictive values and significant relative risk were found for BG thresholds < or = 5.2 mmol/L at dinner time (p < 0.0001) and < or = 6.7 mmol/L at 7 AM (p < 0.0001). When BG values at 10 PM were used, prediction of NH was weak.


CONCLUSIONS
Nocturnal hypoglycemia occurred frequently in children and adolescents with insulin-dependent diabetes mellitus. Our study found risk factors that will help pediatricians to identify those children with a high risk of NH. Especially in these patients, counseling based on the BG values before dinner and early in the morning is indicated to reduce the prevalence of NH.
Beregszàszi
M
M
Department of Pediatric Endocrinology and Diabetology, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, France.
Tubiana-Rufi
N
N
Benali
K
K
Noël
M
M
Bloch
J
J
Czernichow
P
P
D000293:Adolescent; D000367:Age Factors; D001786:Blood Glucose / Q000032:analysis; D002096:C-Peptide / Q000097:blood / Q000652:urine; D002648:Child; D002675:Child, Preschool; D002940:Circadian Rhythm; D015331:Cohort Studies; D003376:Counseling; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000188:drug therapy; D004435:Eating; D005260:Female; D005544:Forecasting; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000209:etiology* / Q000517:prevention & control; D007328:Insulin / Q000008:administration & dosage; D008297:Male; D011237:Predictive Value of Tests; D015995:Prevalence; D011627:Puberty; D012307:Risk Factors; D013997:Time Factors
D001786:Blood Glucose; D002096:C-Peptide; D006442:Glycated Hemoglobin; D007328:Insulin