Episodes of severe hypoglycemia is associated with a progressive increase in hemoglobin A1c in children and adolescents with type 1 diabetes

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Episodes of severe hypoglycemia is associated with a progressive increase in hemoglobin A1c in children and adolescents with type 1 diabetes. / Pilgaard, Kasper A.; Breinegaard, Nina; Johannesen, Jesper; Pörksen, Sven; Fredheim, Siri; Madsen, Mette; Kristensen, Kurt; Svensson, Jannet; Birkebæk, Niels H.

In: Pediatric Diabetes, Vol. 21, No. 5, 08.2020, p. 808-813.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

Harvard

Pilgaard, KA, Breinegaard, N, Johannesen, J, Pörksen, S, Fredheim, S, Madsen, M, Kristensen, K, Svensson, J & Birkebæk, NH 2020, 'Episodes of severe hypoglycemia is associated with a progressive increase in hemoglobin A1c in children and adolescents with type 1 diabetes', Pediatric Diabetes, vol. 21, no. 5, pp. 808-813. https://doi.org/10.1111/pedi.13020

APA

Pilgaard, K. A., Breinegaard, N., Johannesen, J., Pörksen, S., Fredheim, S., Madsen, M., Kristensen, K., Svensson, J., & Birkebæk, N. H. (2020). Episodes of severe hypoglycemia is associated with a progressive increase in hemoglobin A1c in children and adolescents with type 1 diabetes. Pediatric Diabetes, 21(5), 808-813. https://doi.org/10.1111/pedi.13020

CBE

MLA

Vancouver

Pilgaard KA, Breinegaard N, Johannesen J, Pörksen S, Fredheim S, Madsen M et al. Episodes of severe hypoglycemia is associated with a progressive increase in hemoglobin A1c in children and adolescents with type 1 diabetes. Pediatric Diabetes. 2020 Aug;21(5):808-813. https://doi.org/10.1111/pedi.13020

Author

Pilgaard, Kasper A. ; Breinegaard, Nina ; Johannesen, Jesper ; Pörksen, Sven ; Fredheim, Siri ; Madsen, Mette ; Kristensen, Kurt ; Svensson, Jannet ; Birkebæk, Niels H. / Episodes of severe hypoglycemia is associated with a progressive increase in hemoglobin A1c in children and adolescents with type 1 diabetes. In: Pediatric Diabetes. 2020 ; Vol. 21, No. 5. pp. 808-813.

Bibtex

@article{6cde83480249493988a25f81c8132ab8,
title = "Episodes of severe hypoglycemia is associated with a progressive increase in hemoglobin A1c in children and adolescents with type 1 diabetes",
abstract = "Objective: To investigate the trajectory in glycemic control following episodes of severe hypoglycemia (SH) among children and adolescents with type 1 diabetes (T1D). Methods: A Danish national population-based study comprising data from 2008-17. SH was defined according to the 2014 ISPAD guidelines. A mixed model was applied with HbA1c as outcome and SH episodes and time since first episode as explanatory variables. Data were adjusted for age, gender and diabetes duration. Results: A total of 4244 children (51.6% boys) with 18 793 annual outpatient visits were included. Mean (SD) age at diabetes onset was 9.0 (4.1) years. Median diabetes duration at inclusion in the study was 1.2 (Q1 = 0.9, Q3 = 3.0) years, and median diabetes duration at last visit was 5.0 (Q1 = 2.7, Q3 = 8.1) years. A total of 506 children experienced at least one episode of SH during the nine-year follow-up; 294 children experienced one episode, 115 two episodes and 97 three or more episodes of SH. HbA1c increased with episodes of SH and in the years following the first episode. The glycemic trajectory peaked 2 to 3 years after an SH episode. The accumulated deterioration in glycemic control was in the range of 5% in patients with two or more episodes equivalent to an increase in HbA1c of 4 mmol/mol (HbA1c ~0.4%). Conclusion: SH was followed by a progressive and lasting increase in HbA1c among Danish children and adolescents with T1D. Thus, in addition to the known risk of new episodes of hypoglycemia and cognitive impairment, SH contributes to long-term diabetes complications.",
keywords = "adolescents, children, diabetes, HbA1c, severe hypoglycemia",
author = "Pilgaard, {Kasper A.} and Nina Breinegaard and Jesper Johannesen and Sven P{\"o}rksen and Siri Fredheim and Mette Madsen and Kurt Kristensen and Jannet Svensson and Birkeb{\ae}k, {Niels H.}",
year = "2020",
month = aug,
doi = "10.1111/pedi.13020",
language = "English",
volume = "21",
pages = "808--813",
journal = "Pediatric Diabetes",
issn = "1399-543X",
publisher = "Wiley-Blackwell Munksgaard",
number = "5",

}

RIS

TY - JOUR

T1 - Episodes of severe hypoglycemia is associated with a progressive increase in hemoglobin A1c in children and adolescents with type 1 diabetes

AU - Pilgaard, Kasper A.

AU - Breinegaard, Nina

AU - Johannesen, Jesper

AU - Pörksen, Sven

AU - Fredheim, Siri

AU - Madsen, Mette

AU - Kristensen, Kurt

AU - Svensson, Jannet

AU - Birkebæk, Niels H.

PY - 2020/8

Y1 - 2020/8

N2 - Objective: To investigate the trajectory in glycemic control following episodes of severe hypoglycemia (SH) among children and adolescents with type 1 diabetes (T1D). Methods: A Danish national population-based study comprising data from 2008-17. SH was defined according to the 2014 ISPAD guidelines. A mixed model was applied with HbA1c as outcome and SH episodes and time since first episode as explanatory variables. Data were adjusted for age, gender and diabetes duration. Results: A total of 4244 children (51.6% boys) with 18 793 annual outpatient visits were included. Mean (SD) age at diabetes onset was 9.0 (4.1) years. Median diabetes duration at inclusion in the study was 1.2 (Q1 = 0.9, Q3 = 3.0) years, and median diabetes duration at last visit was 5.0 (Q1 = 2.7, Q3 = 8.1) years. A total of 506 children experienced at least one episode of SH during the nine-year follow-up; 294 children experienced one episode, 115 two episodes and 97 three or more episodes of SH. HbA1c increased with episodes of SH and in the years following the first episode. The glycemic trajectory peaked 2 to 3 years after an SH episode. The accumulated deterioration in glycemic control was in the range of 5% in patients with two or more episodes equivalent to an increase in HbA1c of 4 mmol/mol (HbA1c ~0.4%). Conclusion: SH was followed by a progressive and lasting increase in HbA1c among Danish children and adolescents with T1D. Thus, in addition to the known risk of new episodes of hypoglycemia and cognitive impairment, SH contributes to long-term diabetes complications.

AB - Objective: To investigate the trajectory in glycemic control following episodes of severe hypoglycemia (SH) among children and adolescents with type 1 diabetes (T1D). Methods: A Danish national population-based study comprising data from 2008-17. SH was defined according to the 2014 ISPAD guidelines. A mixed model was applied with HbA1c as outcome and SH episodes and time since first episode as explanatory variables. Data were adjusted for age, gender and diabetes duration. Results: A total of 4244 children (51.6% boys) with 18 793 annual outpatient visits were included. Mean (SD) age at diabetes onset was 9.0 (4.1) years. Median diabetes duration at inclusion in the study was 1.2 (Q1 = 0.9, Q3 = 3.0) years, and median diabetes duration at last visit was 5.0 (Q1 = 2.7, Q3 = 8.1) years. A total of 506 children experienced at least one episode of SH during the nine-year follow-up; 294 children experienced one episode, 115 two episodes and 97 three or more episodes of SH. HbA1c increased with episodes of SH and in the years following the first episode. The glycemic trajectory peaked 2 to 3 years after an SH episode. The accumulated deterioration in glycemic control was in the range of 5% in patients with two or more episodes equivalent to an increase in HbA1c of 4 mmol/mol (HbA1c ~0.4%). Conclusion: SH was followed by a progressive and lasting increase in HbA1c among Danish children and adolescents with T1D. Thus, in addition to the known risk of new episodes of hypoglycemia and cognitive impairment, SH contributes to long-term diabetes complications.

KW - adolescents

KW - children

KW - diabetes

KW - HbA1c

KW - severe hypoglycemia

UR - http://www.scopus.com/inward/record.url?scp=85085065617&partnerID=8YFLogxK

U2 - 10.1111/pedi.13020

DO - 10.1111/pedi.13020

M3 - Journal article

C2 - 32304129

AN - SCOPUS:85085065617

VL - 21

SP - 808

EP - 813

JO - Pediatric Diabetes

JF - Pediatric Diabetes

SN - 1399-543X

IS - 5

ER -