title: Long-Term Prediction of Severe Hypoglycemia in Type 1 Diabetes: Is It Really Possible?
abstract: Prediction of risk of severe hypoglycemia (SH) in patients with type 1 diabetes is important to prevent future episodes, but it is unknown if it is possible to predict the long-term risk of SH. The aim of the study is to assess if long-term prediction of SH is possible in type 1 diabetes.
  
  
  
  A follow-up study was performed with 98 patients with type 1 diabetes. At baseline and at follow-up, the patients filled in a questionnaire about diabetes history and complications, number of SH in the preceding year and state of awareness, and HbA1c and C-peptide levels were measured.
  
  
  
  During the 12 years of follow-up, there was a decrease in HbA1c, C-peptide levels, and incidence of SH (1.1 to 0.4 episodes per patient-year; P < .001). At baseline, the relative rate of SH was 3.6 (P = .001) and 10.9 (P < .0001) in patients with impaired awareness and unawareness of hypoglycemia, respectively, as compared to patients with normal awareness. At follow-up, patients with unawareness at baseline tended to have maintained an increased rate of SH (RR = 3.1; P = .07). Impaired awareness, HbA1c and C-peptide determined at baseline did not correspond with an increased rate of SH at follow-up.
  
  
  
  Long-term prediction of severe hypoglycemia in type 1 diabetes was not possible, although baseline hypoglycemia unawareness tended to remain a predictor for risk of SH at follow-up. Therefore, it is important repeatedly to assess the different risk factors of SH to determine the actual risk.
authors.affiliation: Department of Cardiology, Nephrology and Endocrinology, Nordsjællands Hospital Hillerød, Hillerød, Denmark marie.moth.henriksen@regionh.dk.
authors.forename: Marie Moth
authors.initials: MM
authors.lastname: Henriksen
authors.affiliation: Department of Cardiology, Nephrology and Endocrinology, Nordsjællands Hospital Hillerød, Hillerød, Denmark.
authors.forename: Louise
authors.initials: L
authors.lastname: Færch
authors.affiliation: Department of Cardiology, Nephrology and Endocrinology, Nordsjællands Hospital Hillerød, Hillerød, Denmark.|Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Birger
authors.initials: B
authors.lastname: Thorsteinsson
authors.affiliation: Department of Cardiology, Nephrology and Endocrinology, Nordsjællands Hospital Hillerød, Hillerød, Denmark.|Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Ulrik
authors.initials: U
authors.lastname: Pedersen-Bjergaard
mesh_terms: D000328:Adult; D000368:Aged; D002096:C-Peptide / Q000032:analysis*; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000453:epidemiology*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis*; D049670:History, 17th Century; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D015994:Incidence; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D002096:C-Peptide; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: hypoglycemia awareness; prediction; severe hypoglycemia; type 1 diabetes