Prospective cohort study of referred Malawian children and their survival by hypoxaemia and hypoglycaemia status

Objective To investigate survival in children referred from primary care in Malawi, with a focus on hypoglycaemia and hypoxaemia progression. Methods The study involved a prospective cohort of children aged 12 years or under referred from primary health-care facilities in Mchinji district, Malawi in 2019 and 2020. Peripheral blood oxygen saturation (SpO2) and blood glucose were measured at recruitment and on arrival at a subsequent health-care facility (i.e. four hospitals and 14 primary health-care facilities). Children were followed up 2 weeks after discharge or their last clinical visit. The primary study outcome was the case fatality ratio at 2 weeks. Associations between SpO2 and blood glucose levels and death were evaluated using Cox proportional hazards models and the treatment effect of hospitalization was assessed using propensity score matching. Findings Of 826 children recruited, 784 (94.9%) completed follow-up. At presentation, hypoxaemia was moderate (SpO2: 90­93%) in 13.1% (108/826) and severe (SpO2: < 90%) in 8.6% (71/826) and hypoglycaemia was moderate (blood glucose: 2.5­4.0 mmol/L) in 9.0% (74/826) and severe (blood glucose: < 2.5 mmol/L) in 2.3% (19/826). The case fatality ratio was 3.7% (29/784) overall but 26.3% (5/19) in severely hypoglycaemic children and 12.7% (9/71) in severely hypoxaemic children. Neither moderate hypoglycaemia nor moderate hypoxaemia was associated with mortality. Conclusion Presumptive pre-referral glucose treatment and better management of hypoglycaemia could reduce the high case fatality ratio observed in children with severe hypoglycaemia. The morbidity and mortality burden of severe hypoxaemia was high; ways of improving hypoxaemia identification and management are needed.

Incidence of hypoglycaemia in late preterm and term infants born to women with diabetes mellitus

Background. Diabetes mellitus (DM) is a common metabolic disorder affecting pregnant women and is associated with adverse outcomes in their offspring, including hypoglycaemia. The incidence and factors associated with development of hypoglycaemia in infants of diabetic mothers (IDM) from developing countries such as South Africa are not well known. Objectives. To determine the incidence of hypoglycaemia and factors associated with its development in IDM. Methods. Medical records of mothers diagnosed with DM, and their infants who were term and/or late preterm and admitted to the neonatal unit at Chris Hani Baragwanath Academic Hospital, were retrieved and reviewed. Maternal characteristics, type and management of diabetes, infant characteristics and glucose measurements were captured for analysis. Results. Over the 2-year period, 234 infants were born to diabetic mothers (median age 33 years) and 207 met the diagnostic criteria and were admitted for monitoring of blood glucose using the hemoglucotest. Among the mothers with DM, 56% had gestational diabetes; ~19% of IDM were large for gestational age (LGA) and 10% were macrosomic. Hypoglycaemia occurred in 39% of IDM, and 85% of the infants were diagnosed within the first 6 hours of life. There were no statistically significant differences in maternal characteristics, including type of maternal diabetes and its management between hypoglycaemic and normoglycaemic infants. Hypoglycaemic infants were more likely to be LGA (28.2% v. 12.8%; p=0.009). Conclusion: Hypoglycaemia is a common finding in IDM. It presents early (within the first 6 hours of life) and rarely beyond 24 hours after birth. The only characteristic found to be associated with development of hypoglycaemia in IDM was a neonate being LGA

Prevalence and outcome of hypoglycemia in children attending emergency pediatric unit of a specialist hospital in Nigeria

Background: Hypoglycemia is a common metabolic problem encountered in pediatric emergency admissions. The absence of clinical symptoms does not preclude the presence of hypoglycemia as presentation may vary from asymptomatic to central nervous system and cardiopulmonary disturbances. If untreated, hypoglycemia can result in permanent neurological damage or even death. Objectives: The objective of the study is to determine the prevalence, associated factors and outcome of hypoglycemia in pediatric emergency admissions at Ahmad Sani Yariman Bakura Specialist Hospital, Gusau, Nigeria. Materials and Methods: The study was a prospective cross­sectional study involving children aged 1 month­13 years. Blood glucose was determined at admission using Accu­Chek® Active Blood Glucose Meter, and hypoglycemia was defined as blood glucose levels <2.8 mmol/L (<50 mg/dL). Age of the patients, sex, interval of last meal, presenting complaints diagnoses were recorded. Results: A total of 154 children were studied.Thirty (19.5%) were infants and 71 (46.1%) were under­fives. Eighty­seven (56.5%) were males with male to female ratio of 1.3:1.The prevalence of hypoglycemia was 22.1%. The predominant disease conditions the children with hypoglycemia presented with were severe malaria, acute diarrheal disease, and sepsis. The prevalence of hypoglycemia was significantly higher among children whose last meal was 8 h and above before presentation (42.9%). Children who presented with hypoglycemia were significantly more likely to die (odds ratio [OR] =13.3; 95% confidence interval [CI] =4.6­38.7). Among those with hypoglycemia, males were significantly more likely to die (OR = 4.2, 95% CI = 1.0­18.0). Hypoglycemia was significantly associated with mortality in children with severe malaria and pneumonia (P = 0.04 and 0.01, respectively). Conclusion: The prevalence of hypoglycemia is still high in our emergency admissions. It is associated with significant mortality especially among male children and those presenting with severe malaria and pneumonia. We recommend that hypoglycemia sought for and promptly treated in children presenting to emergency to reduce mortality

Incidence of hypoglycaemia in the South African population with diabetes: results from the IDMPS Wave 7 study

Objectives: Management of diabetes is a balancing act of preventing a state of hyperglycaemia while avoiding episodes of hypoglycaemia. Limited information is currently available on the incidence of hypoglycaemia in South African people diagnosed with diabetes. Data regarding the management of diabetes and incidence of hypoglycaemia in the South African population was collected as part of Wave 7 of the International Diabetes Management Practices Study (IDMPS). Design and methods: During this observational study the first 10 adult individuals with type 2 diabetes and the first five adult individuals with type 1 diabetes presenting to a study site during the two-week study period were enrolled. Setting:Patients were enrolled from the private healthcare sector in South Africa only. Subjects:A total of 445 individuals (49 diagnosed with T1D, 396 diagnosed with T2D) were included. Outcome measures:Glycated haemoglobin and hypoglycaemia data were recorded for each patient. Results:Of the patients who reported experiencing hypoglycaemia, 48.6% (17/35) among T1D individuals and 67.8% (40/71) among T2D individuals experienced hypoglycaemia over a four-week period. Furthermore, in patients who discontinued insulin treatment (n= 11), fear of hypoglycaemia was reported to influence adherence to insulin treatment by 27.3% in T1D and T2D individuals. Of the 148 patients not achieving their HbA1c target, 23.0% reported fear of hypoglycaemia as a reason. Conclusions: This report demonstrates the need to address hypoglycaemia and fear of hypoglycaemia in the South African diabetes population

Hypoglycaemia in Children: Review of the Literature

Hypoglycaemia is a common metabolic condition in children. It often presents urgent and therapeutic challenges and it has been documented to affect many childhood conditions. Its clinical presentation is not classical and requires a high index of suspicion for an early diagnosis and prompt management. Undiagnosed or undertreated hypoglycaemia has been found to increase mortality in children when it is present. This review sought to review the subject of hypoglycaemia in children and calls for testing for it in all sick and admitted children

Rôle de l'anémie sévère et de l'hypoglycémie dans la mortalité du paludisme grave de l'enfant en milieu hospitalier à Parakou (Bénin)

BUTS Dans cette étude, l'objectif était de déterminer la part des anémies sévères et des hypoglycémies dans le paludisme grave de l'enfant et d'identifier les facteurs influençant le décès. PATIENTS ET MÉTHODES Il s'est agit d'une étude transversale descriptive et analytique menée de Janvier à Décembre 2009. Elle a inclus les enfants de un mois à quatorze ans révolus hospitalisés dans le Service de Pédiatrie du Centre Hospitalier du Borgou à Parakou (Bénin) pour paludisme grave selon la définition de l'Organisation Mondiale de la Santé (OMS). RÉSULTATS Parmi les 1838 cas, 968 cas (52,6%) avaient présenté soit une anémie sévère, soit une hypoglycémie, soit les deux à la fois. Le taux d'hémoglobine moyen était de 4,94 g/dl avec une glycémie moyenne de 0,45g/l. Le taux de décès était de 8,2%. CONCLUSION Ce travail a confirmé l'importance de l'hypoglycémie et de l'anémie parmi les facteurs associés au décès au cours du paludisme grave de l'enfant

Hypoglycaemia in Children Aged 1 Month to 10 Years Admitted to the Children's Emergency Centre of Lagos University Teaching Hospital; Nigeria

Background. Hypoglycaemia occurs in many disease states common in the tropics; and may also complicate treatment of malaria. It may contribute significantly to morbidity and mortality. Objectives. To determine the prevalence of and clinical conditions associated with hypoglycaemia. Methods. A total of 430 patients aged 1 month to 10 years were recruited consecutively from the Children's Emergency Centre of Lagos University Teaching Hospital. Clinical and demographic data were entered into a predesigned study proforma. Blood glucose was determined in the laboratory using the glucose oxidase method. Hypoglycaemia was defined as plasma glucose 2.5 mmol/L. Results. The median age of the study subjects was 24 months; with a range of 1.5 - 120 months. A total of 248 patients (57.6) were 24 months old. The mean (standard deviation) blood glucose of all the study subjects was 5.19 (2.05) mmol/L (median 4.9 mmol/L). Twenty-four patients (5.6) were hypoglycaemic. The predominant disease conditions in which hypoglycaemia occurred were severe malaria; multisystemic infections; marasmus; malignancies and gastroenteritis. Mortality was higher in hypoglycaemic patients than in those without hypoglycaemia (33.3 v. 5.4; p0.01). Conclusion. Hypoglycaemia complicates many common childhood illnesses seen in the emergency room and is associated with significant mortality. Hypoglycaemia should be suspected in severely ill children with severe malaria; multisystemic infections; marasmus; malignancies and gastroenteritis

Neonatal Cleft Lip Repair in Babies with Breastfeeding Difficulties at Polokwane Mankweng Hospital Complex

Background. A cleft lip (CL) is a congenital abnormality resulting from failure of union of the medial and nasal prominences with the maxillary prominence during embryonic development. CL may be classified as incomplete; complete; unilateral; bilateral or median. It may be associated with a cleft alveolus or a cleft palate. Definitive correction of a cleft lip is by surgery. In most African settings; the birth of a cleft lip and cleft palate (CLP) baby is associated with witchcraft and ancestral spirits. The parents; particularly mothers; are stigmatised.Objective. To repair CLs in neonates with difficulties in breastfeeding. Methods. Non-syndromic term neonates referred to Polokwane Mankweng Hospital Complex (PMHC) from primary and secondary hospitals with CLP and difficulties in breastfeeding were prospectively admitted to the neonatal unit. Our breastfeeding team supervised and assisted them with breastfeeding. The neonates whose breastfeeding was found to be unsatisfactory were considered for neonatal CL repair.Those who breastfed adequately were booked for later lip repair as per the rule of tens and discharged.Results. From June 2009 to March 2012; 60 children with CLP were referred to PMHC; including 36 neonates. Of these; 23 neonates were unable to breastfeed satisfactorily and were operated at a median age of 9 (range 3 - 28) days. The median weight was 2.8 (1.8 - 3.7) kg. The median haemoglobin was 13.1 (11.5 - 16) g/dL. Conclusion. Neonatal CL repair is an alternative for those with breastfeeding difficulties. Eagerness to breastfeed increased following the lip repair with subsequent improvement in maternal confidence and interaction with the baby. At follow up; weight gain was above the 50th centile on the road to health charts. Early surgery prevents exposure of CL to the public with highly positive possible outcome of decreasing the potential for stigmatisation

The Effects of Acute Hypoglycaemia on Cognitive Function in Type 1 Diabetes : Review

Throughout life with type 1 diabetes mellitus people with the condition are exposed to multiple episodes of hypoglycaemia associated with insulin therapy. Hypoglycaemia affects several domains of cognitive function. Studies in non-diabetic adults and in people with type 1 diabetes have shown that almost all domains of cognitive function are impaired to some degree during acute hypoglycaemia; with complex tasks being more greatly affected. The specific cognitive functions of attention and memory are both profoundly impaired during hypoglycaemia. These cognitive processes are fundamental to the performance of many day to day tasks. Their impairment disrupts everyday life and raises safety concerns for the pursuit of activities such as driving. Mood and emotion are also negatively affected by hypoglycaemia; resulting in tense tiredness; while motivation is reduced; and anger may be generated in some individuals. Hypoglycaemia can cause embarrassing social situations; and may lead to chronic anxiety and depression in people with type 1 diabetes. At present few therapeutic measures can modify or ameliorate the effects of hypoglycaemia on cognitive function; so instigation of measures to prevent exposure to hypoglycaemia is of major clinical importance; while preserving good glycaemic control

Hypoglycaemia Unawareness : Practical Avoidance and Management : Review

In diabetic patients requiring insulin; hypoglycaemic events are inevitable and severe hypoglycaemia is one of the most feared complications of the disease. It is associated with not only physical discomfort; cognitive dysfunction and loss of personal control; but sometimes more severe consequences; including coma and death. In comparison with conventional glucose targets; iatrogenic hypoglycaemia is up to six times more common with intensive therapy and remains the most important barrier to sustained good glucose control. Neural tissue is dependent on a continuous supply of glucose for maintenance of function. Consequently; the development of symptoms in response to low glucose levels is essential for recognising impending neuroglycopenia and to provoke timeous corrective measures to restore glucose balance. Unawareness of hypoglycaemia and failure to develop warning symptoms therefore increases the risk of severe hypoglycaemia and its associated morbidity

Optimal Utilisation of Sulphonylureas in Resource-Constrained Settings :Review

Sulphonylureas (SUs) are oral anti-diabetic drugs (OADs) that were introduced more than 60 years ago. Clinicians are familiar with their use and they remain extensively used. However; the SU class is associated with adverse effects of weight gain and hypoglycaemia. In addition; their effects on cardiovascular events remain contentious. Newer classes of anti-diabetic agents have been developed and these agents are weight neutral (di-peptidyl peptidase IV inhibitors); while others reduce weight (glucagon-like peptide analogues and sodium glucose co-transporter inhibitors). Furthermore; the newer agents are less likely to cause hypoglycaemia and have a potentially better cardiovascular safety profile. However; the newer agents are more costly than SUs and their long-term safety is unknown. It is therefore likely that SUs will continue to be used; and more so in resource-limited settings. One may mitigate the adverse effects of weight gain and hypoglycaemia associated with the SU class by using members within this class that are less probable to cause these adverse effects. Furthermore; the specific SU must be used at the lowest effective therapeutic dose. In patients at high risk of SU-induced hypoglycaemic episodes (frail; clinically significant renal impairment); or patients in whom hypoglycaemic episodes may have devastating effects (bus drivers); newer anti-diabetic agents may be a justifiable alternative option

Analyse de la prévalence et des facteurs de l'hypoglycémie chez les enfants âges de 6 à 59 mois souffrant de la malnutrition aigue sévère à l'aiguillage pédiatrique de l'hôpital national de Niamey du 1er au 30 août 2013

Mémoire de fin de cycle pour l'obtention du diplôme de Technicien Supérieur en Santé Publique

Recurrent Hypoglycaemia and Seizures in an HIV-Patient

A young male patient recently diagnosed with HIV presented to us with a septic tibia. He developed recurrent seizures and hypoglycaemia. Terminally he developed a clinical picture of Addison's crisis and disseminated intravascular coagulation. Addison's crisis must always be borne in mind in patients with HIV who are subjected to stressful conditions like surgery

Hypoclycaemia unawareness and falls in older adults with type 2 diabete

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Variation in fasting in blood sugar levels of pregnant and non-pregnant women attending Federal Medical centre, Yenagoa, Bayelsa State, Nigeria

This is a descriptive study on variation in fasting blood sugar level of pregnant and non-pregnant women attending Federal Medical Centre (FMC) Yenagoa, Nigeria in March 2008. Blood sample was taken under strict aseptic technique and tested for fasting blood sugar. The findings were analyzed using t-test and correlation method of statistics. The results showed that fasting blood sugar level for pregnant women was 3.869±0.823 while those of non-pregnant women was 3.784±0.725. The t-test (cal) and t (α) for both pregnant and non-pregnant women were 0.484 and 1.670 respectively. Fasting blood sugar level increases with increasing age and the calculated α value for pregnant and non-pregnant women were 0.77 and 0.0653 respectively, which showed a negative correlation level. However the correlation was independent of pregnancy and the r values for pregnant and non-pregnant women were 0.9976 for both groups. This research showed that no significant difference in fasting blood sugar level exist between pregnant and non-pregnant women used for this study although blood sugar levels correlated with age, weight and level of education

Diabetes: Part 2. Management of Diabetes Including Hypoglycaemia and Complications

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Fasting of Ramadan in Peoples with Diabetes in Benghazi; Libya: an Exploratory Study

Background: The epidemiology of diabetes and Ramadan fasting was reported from many Muslim countries; but not from Libya. Methodology: We interviewed 493 consecutive diabetic patients at Benghazi Diabetes and Endocrine Center for the potential complications of fasting during Ramadan. Results: We found 70of diabetic patients completed the 30 days of Ramadan fasting. Hypo- and hyperglycemia was the most commonly reported complications especially during the first two weeks of Ramadan month. Conclusion: It seems majority of diabetic patients in Libya manage to fast during Ramadan month. Patient education and early planned adjustment of diabetic medication is needed to decrease the frequency of diabetic complication during Ramadan month

Care for People with Diabetes during Haj

Haj is one of the five cardinal components of Islam commonly known as the five pillars of Islam. Approximately two million Muslims perform it each year. Haj involves travel to the holy sites in and around Mecca and Medina during a specified short period of time in a limited space; not usually inhabited by such a large number of people. This article deals with the effects of this event on diabetes and its management. The importance of this arises from the fact during Haj; the person's life routine changes as he travels to a different place of his own for a period of 4-6 weeks where geography; weather; diet; and habits are different. During Haj most people live what is effectively a very basic life in very crowded places. Therefore; medical conditions; such as diabetes; whose management depends on a stable routine; would predictably be affected significantly. People with diabetes should have enough time to consider a management plan for their diabetes. The objectives are to achieve a good control and avoid any complications that may be particularly associated with the conditions faced during Haj

The Effects of Two Differing Techniques on the Accuracy of Reagent Strip Blood Glucose Testing

The use of 70 isopropyl alcohol to prepare the site of skin puncture for reagent strip blood glucose testing has been reported to produce falsely elevated blood glucose levels. The objective of this study was to identify if any significant difference existed between the capillary blood glucose levels of healthy volunteers tested using a capillary blood glucose reagent test strip and reflectance photometer; comparing results obtained (i) with and without the use of 70 isopropyl alcohol to prepare the site of skin puncture and results obtained (ii) with and without 70 isopropyl alcohol using the first and second drops of blood. Data analysis revealed a significant interaction between the two factors specified above. If 70 isopropyl alcohol using the first and second drops of blood. Data analysis revealed a significant interaction between the two factors specified above. If 70 isopropyl alcohol is used to prepare the skin there is a significant elevation of 0.39 mmol/l in mean blood glucose concentration between results obtained using the first and second drops of blood while if the first drop of blood is used there is a significant elevation in mean blood glucose concentration of 0.49 mmol/l between results obtained using and not using 70 isopropyl alcohol to prepare the skin