title: Prevalence and predictors of severe hypoglycemia in Danish children and adolescents with diabetes.
abstract: OBJECTIVE
  To investigate the prevalence of severe hypoglycemia in Danish children and adolescents with type 1 diabetes and to pinpoint predictors of this acute complication in children on modern treatment modalities.
  
  
  METHODS
  The study is based on data from DanDiabKids, a national diabetes register for children and adolescents. The register contains data on patients with type 1 diabetes with an ascertainment rate of 99%. Data from 3320 patients aged 0-18 yr was included in the study period from 1998 to 2009 and analyzed using a negative binomial model.
  
  
  RESULTS
  One thousand nine hundred and ninety-nine episodes of severe hypoglycemia in 867 patients were registered conferring an overall incidence of severe hypoglycemia of 15.1 [95% confident interval (CI): 13.8; 16.4] per 100 patient years. This remained unchanged during the study period. Duration of diabetes, age and treatment in centers managing less than 100 patients significantly increased the risk of severe hypoglycemia (p < 0.001). Patients on insulin pump therapy had a 42% reduced risk of severe hypoglycemia compared with pen treated patients (p = 0.01). Patients treated with five or more daily insulin injections had a 31% (95% CI: 17; 49) reduced risk of severe hypoglycemia compared to patients on fewer daily injections (p = 0.015).
  
  
  CONCLUSIONS
  Despite improvements in metabolic control over a decade the prevalence of severe hypoglycemic events remained unchanged. More intensive treatments such as insulin pump therapy and multiple daily injections on a national level seems to be a protective factor for developing severe hypoglycemia up to 2009.
authors.affiliation: Department of Pediatrics, Herlev University Hospital, Herlev, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Johansen
authors.affiliation: Department of Pediatrics, Herlev University Hospital, Herlev, Denmark.
authors.forename: B
authors.initials: B
authors.lastname: Kanijo
authors.affiliation: Department of Pediatrics, Herlev University Hospital, Herlev, Denmark.|Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: S
authors.initials: S
authors.lastname: Fredheim
authors.affiliation: Department of Pediatrics, Herlev University Hospital, Herlev, Denmark.
authors.forename: B
authors.initials: B
authors.lastname: Olsen
authors.affiliation: Department of Pediatrics, Viborg Regional Hospital, Viborg, Denmark.
authors.forename: B
authors.initials: B
authors.lastname: Hertz
authors.affiliation: Department of Pediatrics, Viborg Regional Hospital, Viborg, Denmark.
authors.forename: M H
authors.initials: MH
authors.lastname: Lauridsen
authors.affiliation: Department of Pediatrics, Herlev University Hospital, Herlev, Denmark.
authors.forename: M L M
authors.initials: ML
authors.lastname: Andersen
authors.affiliation: Department of Pediatrics, Herlev University Hospital, Herlev, Denmark.|Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: H B
authors.initials: HB
authors.lastname: Mortensen
authors.affiliation: Department of Pediatrics, Herlev University Hospital, Herlev, Denmark.|Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Svensson
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000175:diagnosis* / Q000453:epidemiology*; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D007004:Hypoglycemic Agents
keywords: BMI; DCCT; HbA1c; HbA1c IDAA1c; IFCC; SDS; SMBG; glycemic control; pediatric; severe hypoglycemia; type 1 diabetes