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. 2017 Nov;18(7):643-650.
doi: 10.1111/pedi.12477. Epub 2016 Nov 23.

Severe hypoglycemia rates are not associated with HbA1c: a cross-sectional analysis of 3 contemporary pediatric diabetes registry databases

Aveni Haynes  1 , Julia M Hermann  2   3 , Kellee M Miller  4 , Sabine E Hofer  5 , Timothy W Jones  1   6 , Roy W Beck  4 , David M Maahs  7 , Elizabeth A Davis  1   6 , Reinhard W Holl  2   3 ; T1D Exchange, WACDD and DPV registries
Affiliations

Severe hypoglycemia rates are not associated with HbA1c: a cross-sectional analysis of 3 contemporary pediatric diabetes registry databases

Aveni Haynes et al. Pediatr Diabetes. 2017 Nov.

Abstract

Objective: To examine the association between glycated hemoglobin (HbA1c) and severe hypoglycemia rates in patients with type 1 diabetes receiving usual care, by analysing data from the US Type 1 Diabetes Exchange (T1DX), German/Austrian Diabetes Patienten Verlaufsdokumenation (DPV), and Western Australian Children Diabetes Database (WACDD) diabetes registries.

Methods: Data for patients with type 1 diabetes, aged <18 years with a minimum duration of diabetes of 2 years, were extracted from each registry for a 12-month observation period between 2011 and 2012 (7,102 T1DX, 18,887 DPV, and 865 WACDD). Rates of severe hypoglycemia (self-reported loss of consciousness/convulsion) were estimated per 100 patient-years and analyzed by HbA1c, source registry, treatment regimen, and age group.

Results: Overall, the severe hypoglycemia rate per 100 patient years was 7.1, 3.3, and 6.7 in T1DX, DPV, and WACDD patients, respectively. Lower HbA1c was not associated with an increased rate of severe hypoglycemia when examined by source registry, treatment regimen, or age group.

Conclusion: An inverse relationship between mean HbA1c and risk of severe hypoglycemia was not observed in this study of 3, independent cohorts of children and adolescents with type 1 diabetes. Investigation in other large, longitudinal cohorts is recommended to further characterize the contemporary relationship between glycemic control and risk of severe hypoglycemia rates in pediatric patients with type 1 diabetes.

Keywords: adolescent; child; diabetes mellitus; hypoglycemia; registries; type 1.

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Conflict of interest statement

Conflict of interest

A.H., D.M.M, J.M.H., K.M.M., E.A.D., S.E.H., T.W.J., R.W.B., R.W.H. have no conflicts of interest related to this publication to declare. D.M.M. is on the advisory board for Insulet, consults for Abbott, and his institution has received research funding from Medtronic, Dexcom, and Roche. T.W.J. has received honoraria for speaking and advisory board membership from Eli-Lilly, Novo-Nordisk, Sanofi, and Medtronic. R.W.B. institution receives consulting and/or research funding from Dexcom, Bigfoot, Tandem, and Animas.

Figures

FIGURE 1
FIGURE 1
A-C, Unadjusted mean severe hypoglycemia (SH) rate per 100 patient years by glycated hemoglobin (HbA1c) category and registry for (A) all patients combined, (B) patients treated with injections, and (C) patients treated with CSII
FIGURE 2
FIGURE 2
A-C, Severe hypoglycemia rate (SH) adjusted for sex and diabetes duration by registry and glycated hemoglobin (HbA1c) category for patients aged <6 years (A); 6 to <13 years (B) and 13 to <18 years (C). Error bars represent upper and lower 95% confidence interval of estimated marginal mean SH rate. A, Includes patients from the Diabetes Patienten Verlaufsdokumenation (DPV) registry only due to small case numbers in this subgroup in the Type 1 Diabetes Exchange (T1DX), and Western Australian Children Diabetes Database (WACDD) registries
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