RISK-FACTORS OF SEVERE HYPOGLYCEMIA IN ADULT PATIENTS WITH TYPE-I DIABETES - A PROSPECTIVE POPULATION-BASED STUDY

The objective of this study was to identify possible risk factors of s evere hypoglycaemia (SW) in a prospective population based study of ad ult Type I (insulin-dependent) diabetic patients. A representative sam ple of 684 patients (41% women, mean +/- SD age 36 +/- II, diabetes du ration 18 +/- II years), living in the district of Northrhine (9.5 mil lion inhabitants), Germany, were examined in their homes using a mobil e ambulance. A comprehensive baseline assessment of possible predictor s of SH included sociodemographic and disease related variables, hypog lycaemia awareness, diabetes management, and attitudes and behavioural aspects as expressed by the patients. After a mean of 19 +/- 6 months 669 (98%) patients were interviewed about events of SH since the base line examination. Using the multiple Cox proportional hazards model, f ive risk factors of SH were identified: SI-I during the preceding year [hazard ratio (I IR) 2.7, 95% confidence intervals (CI) 1.8-4.2], any history of SII (IIR 1.9, CI 1.1-3.4), C-peptide negativity (HR 4.0, C I 1.2-12.7), social status (WR 0.8 for a difference of 5 units for a v alue range of 0-24, CI 0.6-0.9), and patients' determination to reach normoglycaemia (HR 0.7 for a difference of 1 unit for a value range of 1-6, CI 0.5-0.9), indicating that the lower the social status and the higher the patients' determination to reach normoglycaemia, the highe r the risk of SI-I. After eliminating the history of hypoglycaemia fro m the model, impaired hypoglycaemia awareness and patients' inappropri ate denial of SW as their particular problem became additional signifi cant risk factors of SII. In conclusion, in this population based stud y of adult Spe I diabetic patients, C-peptide negativity, a previous e vent of SI-I, patients' determination to reach normoglycaemia and soci al class were risk factors of SH.