FREQUENCY OF SEVERE HYPOGLYCEMIA IN INSULIN-DEPENDENT DIABETES-MELLITUS CAN BE PREDICTED FROM SELF-MONITORING BLOOD-GLUCOSE DATA

Severe hypoglycemia is associated with insulin-dependent diabetes mell itus and may occur mole frequently as metabolic control approaches nor mal. The goal of this study was to determine whether the frequency of severe hypoglycemia could be predicted by the following predictor vari ables: 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 glycosyl ated hemoglobin-A(1) (HbA(1)). Seventy-eight insulin-dependent diabete s mellitus subjects from 3 different sites had their glycosylated HbA( 1) assayed and then performed 50 SMBG recordings during the next 2-3 w eeks. Over the following 6 months, subjects recorded their severe hypo glycemic episodes (stupor or unconsciousness). There was no difference in the number of severe hypoglycemic episodes between subjects in goo d us. poor metabolic control. A higher frequency of severe hypoglycemi a during the subsequent 6 months was predicted by frequent and extreme low SMBG readings and variability in day to day SMBG readings. Regres sion analysis indicated that 44% of the variance in severe hypoglycemi c episodes could be accounted for by initial measures of BG variance a nd the extent of low BG readings. Patients who recorded variable and f requent very low BG readings during routine SMBG were at higher risk f or subsequent severe hypoglycemia. Individuals who had lower glycosyla ted Hb levels were not at higher risk of severe hypoglycemic episodes.