PREVALENCE AND CHARACTERISTICS OF BRITTLE DIABETES IN BRITAIN

We investigated the prevalence and characteristics of 'brittle diabete s', defined as insulin-dependent diabetes mellitus associated with gly caemic instability of any type, leading to life disruption with recurr ent and/or prolonged hospitalizations. A questionnaire was sent to all physicians and paediatricians running diabetic clinics in the UK, fro m lists held at the British Diabetic Association. A total of 414 britt le patients were reported (72% questionnaire return). Most were young (mean age+/-SD was 26+/-15 years), though there was a small peak at ag es 60-70 years. There was an excess of females (66%) and overall clini c prevalence was 1.2 per 1000 diabetic patients and 2.9 per 1000 insul in-treated diabetic patients. On average, there was 1.0 brittle patien t per diabetic clinic. The most common form of brittleness was recurre nt ketoacidosis (59%), with 17% having predominant hypoglycaemia, and 24% mixed instability. Female excess was highest and mean age lowest i n the recurrent ketoacidosis group, whilst the reverse was true for th ose with recurrent hypoglycaemia. Causes of brittleness were offered b y 58% of consultants, and most (93%) considered various psychosocial p roblems as likely underlying factors. We conclude that brittle diabete s is a small but significant problem, currently affecting about 1 per 1000 diabetic patients. Most, but by no means all, are young females-o ften with recurrent ketoacidosis. Older age groups are more likely to have recurrent hypoglycaemic or mixed types of brittleness. Perceived causes of brittleness are usually psychosocial.