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Heinrich, M. ; Maison, N. ; Achenbach, P. ; Assfalg, R. ; Braig, S.* ; Böcker, D.* ; Dunstheimer, D.* ; Ermer, U.* ; Gavazzeni, A.* ; Gerstl, E.M.* ; Hummel, S. ; Kick, K. ; Müller, H.* ; Nellen-Hellmuth, N.* ; Ockert, C.* ; Sindichakis, M.* ; Tretter, S.* ; Warncke, K. ; Ziegler, A.-G. ; Beyerlein, A.

Fasting hypoglycemia is associated with disease progression in presymptomatic early stage type 1 diabetes.

Pediatr. Diabetes 19, 1238-1242 (2018)

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Objective In children with presymptomatic type 1 diabetes, intermittent hyperglycemia and rising hemoglobin A1c levels are a known signal of progression toward insulin-dependency. Episodes of hypoglycemia, however, have also been reported in one published case. We investigated the prevalence of hypoglycemia and its association with disease progression in children with presymptomatic type 1 diabetes.Methods We compared the frequency of hypoglycemic fasting blood glucose levels (<60mg/dL) in 48 autoantibody negative and 167 multiple beta-cell autoantibody positive children aged 2 to 5years. We classified the autoantibody positive children into three categories based on their glucose levels in fasting state (hypoglycemic [<60mg/dL], normoglycemic [60-99mg/dL] or hyperglycemic [100mg/dL]). We then compared the glucose levels under challenge during oral glucose tolerance tests (OGTTs) between the three categories.Results In the autoantibody positive children, 5.1% of the fasting samples were hypoglycemic, while in the autoantibody negative children no hypoglycemia was observed. Hypoglycemia occurred more often in autoantibody positive children who had already entered stage 2 or stage 3 of type 1 diabetes than in stage 1 patients (P = 0.02). Children who had hypoglycemic compared to normoglycemic fasting blood glucose values had higher 120-minute blood glucose values under OGTT challenge, and a higher rate of pathological OGTTs (P = 0.04).Conclusions Fasting hypoglycemia seems to be an indicator of disease progression in presymptomatic type 1 diabetes and may therefore represent a novel marker for the identification of children who should be monitored more closely for progression toward insulin-dependent type 1 diabetes.

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