An Innovative Approach for Predicting Severe Hypoglycemia
Interestingly, the investigators found that the accuracy of prediction was somewhat higher in type 2 diabetic subjects. This is of particular importance because delayed intensification (i.e., clinical inertia) is most often associated with the treatment of patients with type 2 diabetes.
As the authors suggest, this report on SH sets the groundwork for future study. They report that a major limitation of this study is that patients’ reactions to their SMBG readings were not monitored. Future studies could include measurement of patients’ diabetes management behaviors that were used in association with their SMBG results. Subsequent educational strategies for prevention and treatment approaches could be developed from this information.
Severe hypoglycemia, a potentially life-threatening situation, is one of the main complications of type 1 diabetes mellitus encountered during childhood and adolescence.
It is well established that even when insulin dosage is reduced by 10%, hypoglycemia is common at diabetic summer camps. The objective of this study is to identify factors that will predict which campers will suffer hypoglycemia while at camp so that such events can be prevented making the camping experience safer for diabetic children and adolescents.
The patients in this cohort were all adults. Because hypoglycemia, and particularly SH, is a significant challenge in the management of children with diabetes, it would be interesting to test this SMBG algorithm in children and adolescents. Should it perform as well in children, the benefits for anxious pediatric patients, parents, and school staff members would be enormous.
The potential for integrating these strategies into available SMBG technology, such as using online analysis of SMBG data or integration of algorithms into blood glucose meters, could provide early warnings to patients with hypoglycemia alerts and reports. Individuals would be able to take preventive steps to reduce the impending risk of SH by increasing their testing frequency, being more vigilant for warning signs and symptoms, reducing insulin doses, avoiding strenuous exercise, eating extra carbohydrates, delaying driving, and avoiding delays in mealtimes.
This investigative team’s continued efforts in finding approaches to mitigate the challenges associated with insulin intensification are crucially important in improving patients’ and their practitioners’ ability to effectively achieve euglycemia while avoiding the risks of low blood glucose.
Footnotes
Linda M. Siminerio, RN, PhD, CDE, is director of the University of Pittsburgh Diabetes Institute in Pittsburgh, Pa.
American Diabetes Association(R) Inc., 2012
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Linda M. Siminerio, RN, PhD, CDE
Cox DJ, Gonder-Frederick L, Ritterband L, Clarke W, Kovatachev BP: Prediction of severe hypoglycemia. Diabetes Care 30:1370–1373, 2007