title: Severe hypoglycemic episodes: a persistent threat for children with Type 1 diabetes mellitus and their families.
abstract: BACKGROUND
  As lowering glycated hemoglobin (HbA1c) levels is still the main goal of insulin treatment, severe hypoglycemia (SH) remains a common experience in children with Type 1 diabetes mellitus (T1DM) and their families.
  
  
  OBJECTIVE
  This study aims to evaluate the incidence and the clinical features of SH episodes in our Centre in the last 20 yr.
  
  
  METHODS
  We analyzed SH incidence in 269 patients (pts) diagnosed from 1990 to 2010 (total follow-up 2212.9 pts/yr). Inclusion criteria were at least 3 visits/yr and 1-yr follow- up. SH episode was defined as any condition of low blood glucose requiring third-party assistance.
  
  
  RESULTS
  50.2% of patients experienced at least 1 SH episode for a total of 345 episodes. Whole incidence was 15.6/100 pts/yr, slightly different between first and second decade (12.6 vs 16.5, p=0.047). HbA1c at the time of SH was lower in the non-basal bolus group (7.4±1.3 vs 8.2±1.4; p=0.0001) and worsened 3 months later (p=0.0001). Impaired awareness was the main or only symptom in 43.5%. SH occurred at night in 32% of patients; they were significantly younger than those with SH at other times. Five SH episodes or more occurred in 8.1% of patients who presented a lower HbA1c, a younger age and shorter disease duration than the other patients. HbA1c at first SH was negatively correlated with number of SH (r=-0.20; p=0.05).
  
  
  CONCLUSIONS
  Despite the advent of new insulin regimens, we confirm that SH still represents a relevant risk and a current threat for patients with T1DM and their families.
authors.affiliation: Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 11, 40138 Bologna, Italy. giuliomalto@libero.it.
authors.forename: G
authors.initials: G
authors.lastname: Maltoni
authors.forename: S
authors.initials: S
authors.lastname: Zucchini
authors.forename: M
authors.initials: M
authors.lastname: Scipione
authors.forename: A
authors.initials: A
authors.lastname: Rollo
authors.forename: C
authors.initials: C
authors.lastname: Balsamo
authors.forename: C
authors.initials: C
authors.lastname: Bertolini
authors.forename: F
authors.initials: F
authors.lastname: Baronio
authors.forename: R
authors.initials: R
authors.lastname: Rondelli
authors.forename: A
authors.initials: A
authors.lastname: Pession
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000150:complications*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000453:epidemiology*; D015994:Incidence; D007223:Infant; D007558:Italy / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin