Prevalence and characteristics of brittle diabetes in Britain |
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Authors: | Gill GV; Lucas S; Kent LA |
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Institution: | Walton Diabetes Centre, Walton Hospital, Liverpool, UK. |
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Abstract: | We investigated the prevalence and characteristics of 'brittle diabetes',
defined as insulin-dependent diabetes mellitus associated with glycaemic
instability of any type, leading to life disruption with recurrent and/or
prolonged hospitalizations. A questionnaire was sent to all physicians and
paediatricians running diabetic clinics in the UK, from lists held at the
British Diabetic Association. A total of 414 brittle patients were reported
(72% questionnaire return). Most were young (mean age +/- SD was 26 +/- 15
years), though there was a small peak at ages 60-70 years. There was an
excess of females (66%) and overall clinic prevalence was 1.2 per 1000
diabetic patients and 2.9 per 1000 insulin-treated diabetic patients. On
average, there was 1.0 brittle patient per diabetic clinic. The most common
form of brittleness was recurrent ketoacidosis (59%), with 17% having
predominant hypoglycaemia, and 24% mixed instability. Female excess was
highest and mean age lowest in the recurrent ketoacidosis group, whilst the
reverse was true for those with recurrent hypoglycaemia. Causes of
brittleness were offered by 58% of consultants, and most (93%) considered
various psychosocial problems as likely underlying factors. We conclude
that brittle diabetes is a small but significant problem, currently
affecting about 1 per 1000 diabetic patients. Most, but by no means all,
are young females--often with recurrent ketoacidosis. Older age groups are
more likely to have recurrent hypoglycaemic or mixed types of brittleness.
Perceived causes of brittleness are usually psychosocial.
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