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ISSN: 2155-6156

Journal of Diabetes & Metabolism
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Research Article

Dynamic Stress Factor (DySF): A Significant Predictor of Severe Hypoglycemic Events in Children with Type 1 Diabetes

Rawlings RA1,2, Yuan L3,4, Shi H5, Brehm W6, Pop-Busui R6,7 and Nelson PW1*

1Center for Computational Medicine and Bioinformatics, University of Michigan, USA

2Departments of Biophysics, University of Michigan, USA

3Departments of Mathematics, University of Michigan, USA

4University of Michigan Program in Informatics, University of Michigan, USA

5University of Michigan Medical School, USA

6Brehm Center for Diabetes Research, University of Michigan, USA

7Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, USA

*Corresponding Author:
Patrick Nelson
Center for Computational Medicine and Bioinformatics
100 Washtenaw Ave, University of Michigan, Ann Arbor
MI 48109-1055, USA
Tel: (734) 763-3408
Fax: (734) 615-6553
E-mail: [email protected]

Received date: January 17, 2012; Accepted date: February 24, 2012; Published date: February 28, 2012

Citation: Rawlings RA, Yuan L, Shi H, Brehm W, Pop-Busui R et al. (2012) Dynamic Stress Factor (DySF): A Significant Predictor of Severe Hypoglycemic Events in Children with Type 1 Diabetes. J Diabetes Metab 3:177. doi:10.4172/2155-6156.1000177

Copyright: © 2012 Rawlings RA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Hemoglobin A1c (HbA1c) is the current standard used in the clinical treatment of patients with diabetes. However, it has been shown that patients with similar HbA1c values may have widely different fluctuations in blood glucose values over the same period of time, including time spent in hyper- and/or hypo-glycemia. Hence, there exists a need for quantitative measures that can supplement HbA1c in managing patients with diabetes. We introduce and compare the Dynamic Stress Factor, DySF, a newly developed metric that quantifies glycemic volatility based on patient-specific glucose transition density profiles with HbA1c and with currently used glucose variability metrics in predicting severe hypoglycemia in children with type 1 diabetes. DySF, the daily weighted number of large monotonic glycemic transitions that occur within one hour, was calculated for 441 total subjects with type 1 diabetes (146 children, aged 8-14 yrs) to assess the magnitude and frequency of glucose transitions per day. Severe hypoglycemic episodes (HE) were quantified for all subjects and evaluated against HbA1c and existing measures of glucose variability, including SD, MAGE, MODD, and CONGA using logistic regression models. DySF was found to be a predictor of severe HE in children (p = 0.018) with the likelihood of a child, aged 8-14 yrs, experiencing severe hypoglycemia increasing by up to 20% with decreasing values of up to 60% of DySF. Patients of any age who had one or multiple severe hypoglycemic episodes had on average a lower DySF when compared to those with no HE. Additionally, when considering mean glucose levels, DySF/mean was a preliminary predictor of severe HE in patients with HbA1c ≤ 6.5% (p = 0.062). DySF is a dynamic, quantitative, measure of daily glucose “volatility” that separates patients, within the same strata of HbA1c, into visually distinct patient profiles. DySF can be used as a preliminary predictor of clinically severe hypoglycemia in children and “well-controlled” patients with HbA1c ≤ 6.5%.

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