Yale Response to Countdown Article About Nighttime Testing
Jo Ann Ahern's comments in the recent issue of Countdown magazine have generated considerable controversy regarding blood glucose testing during the night in children with type 1 diabetes. In response to this issue, it is important to note that the Yale Children's Diabetes Program recognizes that:
- Severe hypoglycemia remains the most serious obstacle to successful treatment of T1DM.
- Fear of hypoglycemia is a justified and major concern of parents and their children.
- All reasonable measures should be taken to reduce the risk of severe hypoglycemia, including blood glucose testing during the night.
- Such testing is particularly appropriate in younger children and in circumstances with increased risk of nocturnal hypoglycemia, such as after days of increased physical activity
- Further research in the area of glucose sensors and other technologies is needed to reduce or even eliminate the risk of severe hypoglycemia, especially during the night.
In the meantime, patients with T1DM literally walk a tight rope between too high and too low blood glucose levels. While trying to limit the every day burdens of diabetes treatment whenever possible, clinicians who care for children and adolescents with diabetes strive to achieve as good metabolic control as safely possible, which ultimately depends on frequent blood glucose testing. We believe that Mrs. Ahern's comments were directed at the relatively unusual circumstances where fear of hypoglycemia leads to what may appear to be excessive blood glucose testing in situations where it may not be necessary. For example, frequent overnight testing is usually not needed in children with diabetes of relatively short duration who are at low risk of hypoglycemia. However, it is the parents, in consultation with their treating clinicians, who must make the decision regarding the frequency of nighttime blood glucose testing that best serves the health and welfare of their child.
William V. Tamborlane, M.D.
Professor and Chief of Pediatric Endocrinology
Robert S. Sherwin, M.D.
C.N.H. Long Professor of Internal Medicine
Yale University School of Medicine
New Haven, CT
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