Detection of hypoglycemia by children with type 1 diabetes 6 to 11 years of age and their parents: a field study.
OBJECTIVE
The objectives of this study were to (1) assess accuracy of hypoglycemia detection in children with type 1 diabetes and their parents, using personal digital assistant technology to collect glucose estimates and meter readings, (2) identify demographic, clinical, and psychological predictors of individual differences in accuracy, and (3) test whether poor hypoglycemia detection is a risk factor for severe hypoglycemia in children.


METHODS
Sixty-one children aged 6 to 11 and their parents completed 70 trials, over 1 month, of a survey programmed on a personal digital assistant, which asked them to rate symptoms, estimate current blood glucose level, and then measure blood glucose level. For the subsequent 6 months, parents reported children's severe hypoglycemia episodes bimonthly.


RESULTS
Both parents and children showed poor ability to recognize high or low blood glucose levels, making clinically significant errors as frequently as clinically accurate estimates. Parents failed to recognize >50% of readings <3 mmol/L (<55 mg/dL) and made potentially dangerous errors such as believing the blood glucose level was high when it was low 17% of the time. Children were significantly more accurate at recognizing their hypoglycemia but still failed to detect >40% of episodes. Higher depression scores for children related to lower accuracy. Children who were less accurate at detecting hypoglycemia subsequently experienced more severe hypoglycemia.


CONCLUSIONS
Ability to recognize hypoglycemia is a significant problem for children with type 1 diabetes and their parents. For children, poor ability to detect low blood glucose levels may be a significant and underappreciated risk factor for severe hypoglycemia. More effort is needed to provide education and training designed to improve hypoglycemia detection in this population.
Gonder-Frederick
Linda
L
Department of Psychiatry and Neurobehavioral Sciences, Behavioral Medicine Center, University of Virginia, Charlottesville, VA 22908, USA. lag3g@virginia.edu
Zrebiec
John
J
Bauchowitz
Andrea
A
Lee
Jarim
J
Cox
Daniel
D
Ritterband
Lee
L
Kovatchev
Boris
B
Clarke
William
W
D001786:Blood Glucose / Q000032:analysis; D015190:Blood Glucose Self-Monitoring / Q000592:standards* / Q000639:trends; D002648:Child; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis* / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000175:diagnosis*; D015994:Incidence; D007279:Injections, Subcutaneous; D007328:Insulin / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D010287:Parent-Child Relations; D010353:Patient Education as Topic; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
D001786:Blood Glucose; D007328:Insulin