Improving the management of dysglycemia in children in the developing world

Abstract

Improving the availability of point-of-care (POC) diagnostics for glucose is crucial in resource-constrained settings (RCS). Both hypo and hyperglycemia have an appreciable frequency in the tropics and have been associated with increased risk of deaths in pediatrics units. However, causes of dysglycemia, including hyperglycemia, are numerous and insufficiently documented in RCS. Effective glycemic control with glucose infusion and/or intensive insulin therapy can improve clinical outcomes in western settings. A non-invasive way for insulin administration is not yet available for hyperglycemia. We documented a few causes and developed simple POC treatment of hypoglycemia in RCS. We showed the efficacy of sublingual sugar in two clinical trials. Dextrose gel has been recently tested for neonate mortality. This represents an interesting alternative that should be compared with sublingual sugar in RCS. New studies had to be done to document dysglycemia mechanism, frequency and morbid-mortality, and safe POC treatment in the tropics.

Figure 1.

Mean delta of initial blood glucose concentration (g/L) after sublingual and oral sugar, and placebo (water) in young children in the tropics. Sixty-nine children (3–13 years of age) with blood glucose concentration < 3.9 mmol/L after overnight fasting randomly received 2.5 g of moistened sugar either orally or sublingually, oral water as placebo. Adapted from Barennes and others.