title: Severe hypoglycemia and diabetic ketoacidosis in adults with type 1 diabetes: results from the T1D Exchange clinic registry.
abstract: BACKGROUND
  Few studies have assessed factors associated with severe hypoglycemia (SH) and diabetic ketoacidosis (DKA) in adults with type 1 diabetes (T1D).
  
  
  OBJECTIVE
  Our objective was to determine frequency of and factors associated with the occurrence of SH and DKA in adults with T1D.
  
  
  METHODS
  We conducted a cross-sectional analysis from the T1D Exchange clinic registry at 70 U.S. endocrinology centers.
  
  
  METHODS
  Analysis included 7012 participants in the T1D Exchange clinic registry aged 26 to 93 years old with T1D for ≥2 years.
  
  
  RESULTS
  Higher frequencies of SH and DKA were associated with lower socioeconomic status (P < .001). SH was strongly associated with diabetes duration (P < .001), with 18.6% of those with diabetes ≥40 years having an event in the past 12 months. SH frequency was lowest in those with hemoglobin A1c (HbA1c) levels of 7.0% (53 mmol/mol) to 7.5% (58 mmol/mol), being higher in those with HbA1c levels <7.0% (<53 mmol/mol) or >7.5% (>58 mmol/mol). DKA frequency increased with higher HbA1c levels (P < .001), with 21.0% of those with HbA1c ≥10.0% (≥86 mmol/mol) having an event in the past 12 months.
  
  
  CONCLUSIONS
  SH and DKA are more common in those with lower socioeconomic status. DKA, most common in those with HbA1c ≥10.0% (≥86 mmol/mol), should be largely preventable. In contrast, SH, most frequent with diabetes ≥40 years duration, cannot be abolished given the limitation of current therapies. To reduce SH in adults with longstanding diabetes, consideration should be given to modifying HbA1c goals, particularly in patients with very low HbA1c levels.
authors.affiliation: State University of New York Upstate Medical University, Syracuse, New York 13210, USA.
authors.forename: Ruth S
authors.initials: RS
authors.lastname: Weinstock
authors.forename: Dongyuan
authors.initials: D
authors.lastname: Xing
authors.forename: David M
authors.initials: DM
authors.lastname: Maahs
authors.forename: Aaron
authors.initials: A
authors.lastname: Michels
authors.forename: Michael R
authors.initials: MR
authors.lastname: Rickels
authors.forename: Anne L
authors.initials: AL
authors.lastname: Peters
authors.forename: Richard M
authors.initials: RM
authors.lastname: Bergenstal
authors.forename: Breanne
authors.initials: B
authors.lastname: Harris
authors.forename: Stephanie N
authors.initials: SN
authors.lastname: Dubose
authors.forename: Kellee M
authors.initials: KM
authors.lastname: Miller
authors.forename: Roy W
authors.initials: RW
authors.lastname: Beck
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D016883:Diabetic Ketoacidosis / Q000209:etiology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012042:Registries
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human