Incidence and factors associated with hypoglycemia in newly diagnosed hospitalized children and adolescents with type 1 diabetes mellitus in China

Abstract

Abstract

Objective To investigate the incidence and associated factors of hypoglycemia in hospitalized children and adolescents with newly diagnosed type 1 diabetes mellitus(T1DM) at a pediatric medical center in China. Research design and methods This retrospective study included 567 children and adolescents aged <18 years with newly diagnosed T1DM hospitalized between January 1, 2016, and January 1, 2023. Hypoglycemia was defined as blood glucose <3.9 mmol/L (grade 1: 3.0–3.9 mmol/L; grade 2: <3.0 mmol/L).Between-group comparisons were performed using independent samples t-test, χ2-test, Mann-Whitney U-test, and binary logistic regression analysis to identify factors associated with hypoglycemia. Results Among 567 patients, The total number of blood glucose measurements during hospitalization was 50,626.Hypoglycemia (<3.9 mmol/L) occurred 2,545 times, with an incidence density of 5.03%.Regarding severity 1,995 episodes of grade 1 hypoglycemia occurred(incidence density 3.94%), and 550 episodes of grade 2 hypoglycemia occurred(incidence density 1.08%).In terms of frequency, 81.66% (463/567) of patients had at least 1 hypoglycemia episode during hospitalization. Among those, 15.87% (90/567) had one episode, 12.52% (71/567) had two episodes, and 53.26% (302/567) had three or more episodes. The recurrence rate (≥2 episodes) was 65.78%(373/567 ).Regarding timing, grade 1 hypoglycemia occurred most frequently at night (00:00–06:00), while the highest event density for grade 2 was observed in the pre-lunch period (09:00–12:00). Multifactorial logistic regression analysis showed that age 7–12 years(OR = 0.421,95%CI=0.244-0.727,p = 0.002),longer hospitalization days (OR=1.346,95%CI=(1.217-1.488, p<0.001), use of multiple daily injections (MDI) + continuous subcutaneous insulin infusion (CSII) regimen (OR = 3.232, 95%CI=1.399-7.469, p=0.006), fasting C-peptide (OR = 0.200, 95%CI=0.076-0.525, p = 0.001), and fasting insulin (OR = 0.938, 95%CI=0.890-0.988, p=0.017) were independently associated with hypoglycemia. Conclusions Hypoglycemia is common among newly diagnosed hospitalized children and adolescents with T1DM in China, particularly at night for grade 1 events. Age, hospitalization days, insulin regimen, fasting C-peptide, and fasting insulin were associated with hypoglycemia. These associations, particularly for insulin regimen, should be interpreted considering potential confounding by indication due to the observational study design. These findings may inform targeted prevention strategies.