title: Nationwide reduction in the frequency of severe hypoglycemia by half.
abstract: OBJECTIVE
  To examine contemporary rates of severe hypoglycemia (SH) and identify the effect of predictors of SH in a pediatric type 1 diabetes population.
  
  
  METHODS
  The national diabetes register provided data on children residing in Denmark from 2008 to 2013 in this register-based population study. Robust Poisson regression models were applied.
  
  
  RESULTS
  The study population [n = 2,715 (50.9 % boys), mean (SD) age at onset; 8.1 (4.0) years, diabetes duration; 5.6 (4.9) years] comprised 7,390 person-years of data and 561 events of SH. The overall incidence of SH was 7.6 per 100 person-years. The incidence rate peaked with 16.0 per 100 person-years in 2008 reaching a nadir of 4.9 in 2011. Overall, insulin pump reduced the rate of SH with 27 % compared to any pen treatment (P = 0.003). When stratifying pen treatment, premixed insulin increased the rate of SH by 1.9-fold (P = 0.0015) and NPH increased the rate by 1.6-fold (P = 0.003) versus pump treatment, whereas long-acting insulin analogues were comparable with pump treatment (P = 0.1485). We found no association of SH with glycemic control (P > 0.05).
  
  
  CONCLUSIONS
  A nationwide halving in rates of severe hypoglycemia was observed during the study period independent of the prevailing average HbA1c level. Changes in diabetes care and successful educational programs may have influenced the lower incidence rate of severe hypoglycemia.
authors.affiliation: Department of Pediatrics, Herlev Hospital, Arkaden, Turkisvej 14, 2730, Herlev, Copenhagen, Denmark, sirifredheim@dadlnet.dk.
authors.forename: S
authors.initials: S
authors.lastname: Fredheim
authors.forename: A
authors.initials: A
authors.lastname: Johansen
authors.forename: S U
authors.initials: SU
authors.lastname: Thorsen
authors.forename: B
authors.initials: B
authors.lastname: Kremke
authors.forename: L B
authors.initials: LB
authors.lastname: Nielsen
authors.forename: B S
authors.initials: BS
authors.lastname: Olsen
authors.forename: L
authors.initials: L
authors.lastname: Lyngsøe
authors.forename: S M
authors.initials: SM
authors.lastname: Sildorf
authors.forename: C
authors.initials: C
authors.lastname: Pipper
authors.forename: H B
authors.initials: HB
authors.lastname: Mortensen
authors.forename: J
authors.initials: J
authors.lastname: Johannesen
authors.forename: J
authors.initials: J
authors.lastname: Svensson
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003718:Denmark / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy / Q000453:epidemiology*; D007328:Insulin / Q000008:administration & dosage; D008297:Male
chemical_list: D007328:Insulin