Schwere Hypoglykämien bei Kindern und Jugendlichen mit Diabetes mellitus Typ 1: Einfluß auf die körperliche und psychomentale Entwicklung

Abstract

This retrospective study investigated the influence of severe hypoglycaemia on the development of children and adolescents with type 1 diabetes mellitus. The study sample consisted of 66 girls and boys: 22 diabetic children with no history of severe hypoglycaemia (median age 11,5 years), 25 diabetic children, who had suffered at least one episode of severe hypoglycaemia (median age 13,1 years) and 19 healthy children as nondiabetic control subjects (median age 11,6 years). Hypoglycaemia was defined as severe, if the patient was not able to help himself and needed assistance of another person. After detailed exploration, every child was examined neurologically. Motor development was tested by using the Hamm-Marburger Körperkoordinationstest für Kinder (KTK). Intellectual status was assessed with the German versions of the Wechsler Intelligence Scales (HAWIK-R and HAWIE-R). Statistical analyses had to be explorative, because the test subjects were not randomly selected and could not be thought representative. Therefore, test results could not be expressed as "significant" or "not significant".
As part of the neurological examination the surface sensibility was tested by writing with the finger-tip numbers on the subjects skin. The children had to recognize these numbers with closed eyes. Poor performance showed 5 % of the control children, 15 % of the diabetic children without severe hypoglycaemia and 29 % of the diabetic children with severe hypoglycaemia. However, with statistical methods, a between-group difference could not been shown. The results of the Körperkoordinationstest für Kinder (KTK) are expressed as motoricity quotient (MQ). This value was in median in the normal range for all three examined groups with no statistical between-group differences. There was a slightly lower MQ in the children with severe hypoglycaemia. This could be an indication to discrete motor impairment of the children. But these findings should be interpreted carefully. Further investigations on larger study samples are needed. The results of the intelligence testing were in the normal range in all three groups. Full scale IQ, verbal IQ and performance IQ scores were collected. There was no indication to any impairment due to severe hypoglycaemia or diabetes mellitus.
In summary, the present data showed no obvious impairment subsequent to severe hypoglycaemia in children and adolescents with diabetes mellitus. There were discrete problems regarding motor ability and surface sensibility. For a more detailed interpretation of these findings, further standardized investigations are necessary.