Prevalence and characteristics of brittle diabetes in Britain

We investigated the prevalence and characteristics of 'brittle diabetes',defined as insulin-dependent diabetes mellitus associated with glycaemicinstability of any type, leading to life disruption with recurrent and/orprolonged hospitalizations. A questionnaire was sent to all physicians andpaediatricians running diabetic clinics in the UK, from lists held at theBritish Diabetic Association. A total of 414 brittle patients were reported(72% questionnaire return). Most were young (mean age +/- SD was 26 +/- 15years), though there was a small peak at ages 60-70 years. There was anexcess of females (66%) and overall clinic prevalence was 1.2 per 1000diabetic patients and 2.9 per 1000 insulin-treated diabetic patients. Onaverage, there was 1.0 brittle patient per diabetic clinic. The most commonform of brittleness was recurrent ketoacidosis (59%), with 17% havingpredominant hypoglycaemia, and 24% mixed instability. Female excess washighest and mean age lowest in the recurrent ketoacidosis group, whilst thereverse was true for those with recurrent hypoglycaemia. Causes ofbrittleness were offered by 58% of consultants, and most (93%) consideredvarious psychosocial problems as likely underlying factors. We concludethat brittle diabetes is a small but significant problem, currentlyaffecting about 1 per 1000 diabetic patients. Most, but by no means all,are young females--often with recurrent ketoacidosis. Older age groups aremore likely to have recurrent hypoglycaemic or mixed types of brittleness.Perceived causes of brittleness are usually psychosocial.