title: New risk and protective factors for severe hypoglycaemia in people with type 1 diabetes.
abstract: OBJECTIVE
  To evaluate risk factors for severe hypoglycaemia (SH) in patients with type 1 diabetes (T1DM).
  
  
  RESULTS
  Retrospective observational and comparative study. All SH occurring between 2007 and 2014 in a German population (Lippe-Detmold) were captured. Characteristics of patients with T1DM and SH were compared with a control group being equivalent concerning age, diabetes duration, HbA1c, comorbidity, and β-blocker treatment. SH was defined as a symptomatic event requiring treatment with intravenous glucose or glucagon administration and being confirmed by a blood glucose measurement of <2.8 mmol/l. Predictive factors for SH were analysed by a multivariable regression model. As many as 405 cases of SH in T1DM occurred in 206 subjects; 50% of episodes were related to 31 patients who experienced ≥3 SH. Need for nursing care (OR 4.88), treatment with NPH (OR 3.68), and impaired hypoglycaemia awareness (OR 2.06) were the strongest risk factors for SH (all p < 0.05, all pFDR-adjusted < 0.10; false discovery rate (FDR)). Depression (OR 0.14), treatment with CSII (OR 0.39) and short-acting insulin analogues (OR 0.31) appeared to be protective (all p < 0.10; FDR-adjusted). The probability of SH onset was significantly higher in patients who had previously experienced recurrent SH episodes. β-Blocker treatment did not appear to be a risk factor.
  
  
  CONCLUSIONS
  The complex risk for SH in people with T1DM can be reduced by treatment with CSII and short-acting analogues. Future structures of diabetes care will be challenged by the need of treating increasingly geriatric subjects with T1DM having a high risk of SH.
authors.affiliation: Leipzig University Medical Center, IFB AdiposityDiseases, Leipzig, Germany. Electronic address: Tobias.Wohland@medizin.uni-leipzig.de.
authors.forename: T
authors.initials: T
authors.lastname: Wohland
authors.affiliation: Division of Nephrology and Internal Intensive Care Medicine, Charité University Medicine Berlin, Germany.
authors.forename: J D
authors.initials: JD
authors.lastname: Holstein
authors.affiliation: 1st Department of Medicine, Lippe-Detmold Hospital, Detmold, Germany.
authors.forename: O M
authors.initials: OM
authors.lastname: Patzer
authors.affiliation: Coordinating Centre for Clinical Trials, University of Leipzig, Leipzig, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Mende
authors.affiliation: Outpatient Diabetes Center, Rinteln, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Tiemann
authors.affiliation: Department of Diabetology, Diakonieklinikum, Rotenburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Koch-Tessarek
authors.affiliation: Leipzig University Medical Center, IFB AdiposityDiseases, Leipzig, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Kovacs
authors.affiliation: 1st Department of Medicine, Lippe-Detmold Hospital, Detmold, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Holstein
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D004334:Drug Administration Schedule; D004339:Drug Compounding; D005260:Female; D005858:Germany; D006442:Glycated Hemoglobin / Q000378:metabolism; D064650:Home Health Nursing; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects*; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009735:Nursing Homes; D016017:Odds Ratio; D016016:Proportional Hazards Models; D065840:Protective Factors; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: Risk factors; Severe hypoglycaemia; Type 1 diabetes