Journal of Clinical Endocrinology & Metabolism, Vol 79, 1659-1662, Copyright © 1994 by Endocrine Society

ARTICLES

Frequency of severe hypoglycemia in insulin-dependent diabetes mellitus can be predicted from self-monitoring blood glucose data

DJ Cox, BP Kovatchev, DM Julian, LA Gonder-Frederick, WH Polonsky, DG Schlundt and WL Clarke
University of Virginia Health Sciences Center, Charlottesville 22908.

Severe hypoglycemia is associated with insulin-dependent diabetes mellitus and may occur more frequently as metabolic control approaches normal. The goal of this study was to determine whether the frequency of severe hypoglycemia could be predicted by the following predictor variables: 1) frequency and degree of low blood glucose (BG) readings, 2) degree of BG variability during routine self-monitoring blood glucose (SMBG) readings, and 3) level of glycemic control measured by glycosylated hemoglobin-A1 (HbA1). Seventy-eight insulin-dependent diabetes mellitus subjects from 3 different sites had their glycosylated HbA1 assayed and then performed 50 SMBG recordings during the next 2-3 weeks. Over the following 6 months, subjects recorded their severe hypoglycemic episodes (stupor or unconsciousness). There was no difference in the number of severe hypoglycemic episodes between subjects in good vs. poor metabolic control. A higher frequency of severe hypoglycemia during the subsequent 6 months was predicted by frequent and extreme low SMBG readings and variability in day to day SMBG readings. Regression analysis indicated that 44% of the variance in severe hypoglycemic episodes could be accounted for by initial measures of BG variance and the extent of low BG readings. Patients who recorded variable and frequent very low BG readings during routine SMBG were at higher risk for subsequent severe hypoglycemia. Individuals who had lower glycosylated Hb levels were not at higher risk of severe hypoglycemic episodes.

This article has been cited by other articles:

				D. J. Cox, L. Gonder-Frederick, L. Ritterband, W. Clarke, and B. P. Kovatchev Prediction of Severe Hypoglycemia Diabetes Care, June 1, 2007; 30(6): 1370 - 1373. [Abstract] [Full Text] [PDF]

				D. J. Cox, B. Kovatchev, K. Vandecar, L. Gonder-Frederick, L. Ritterband, and W. Clarke Hypoglycemia Preceding Fatal Car Collisions Diabetes Care, February 1, 2006; 29(2): 467 - 468. [Full Text] [PDF]

				S. A. Soutor, R. Chen, R. Streisand, P. Kaplowitz, and C. S. Holmes Memory Matters: Developmental Differences in Predictors of Diabetes Care Behaviors J. Pediatr. Psychol., October 1, 2004; 29(7): 493 - 505. [Abstract] [Full Text] [PDF]

				G. H. Murata, R. M. Hoffman, J. H. Shah, C. S. Wendel, and W. C. Duckworth A Probabilistic Model for Predicting Hypoglycemia in Type 2 Diabetes Mellitus: The Diabetes Outcomes in Veterans Study (DOVES) Arch Intern Med, July 12, 2004; 164(13): 1445 - 1450. [Abstract] [Full Text] [PDF]

				G. Vincze and A. Parthan The Value of Home Monitoring Kits in Diabetes, Hypertension, Asthma, and Oral Anticoagulation Therapy Journal of Pharmacy Practice, June 1, 2004; 17(3): 182 - 196. [Abstract] [PDF]

				C. Allen, T. LeCaire, M. Palta, K. Daniels, M. Meredith, and D. J. D'Alessio Risk Factors for Frequent and Severe Hypoglycemia in Type 1 Diabetes Diabetes Care, November 1, 2001; 24(11): 1878 - 1881. [Abstract] [Full Text] [PDF]

				D. J. Cox, L. Gonder-Frederick, W. Polonsky, D. Schlundt, B. Kovatchev, and W. Clarke Blood Glucose Awareness Training (BGAT-2): Long-term benefits Diabetes Care, April 1, 2001; 24(4): 637 - 642. [Abstract] [Full Text]

				W. L. Clarke, D. J. Cox, L. A. Gonder-Frederick, D. Julian, D. Schlundt, and W. Polonsky The Relationship Between Nonroutine Use of Insulin, Food, and Exercise and the Occurrence of Hypoglycemia in Adults With IDDM and Varying Degrees of Hypoglycemic Awareness and Metabolic Control The Diabetes Educator, January 1, 1997; 23(1): 55 - 58. [PDF]