New publication about hypoglycemia treatment to severely sick children in low income countries
Hi Helena Hildenwall, one of the authors of the publication and member of the Global Child Health and SDG’s research group at the Department of Global Public Health. What are the most important results of your study?
“We show that treatment with intravenous dextrose to severely sick children presenting to hospitals with low blood glucose concentrations does not reduce the mortality in low income countries. Mortality among both intervention and control children was high, 16 % in the control group and 15 % in the intervention group.”
How did you perform the study?
“We did a pragmatic randomised controlled trial in two referral hospitals in Malawi. Children between one month and five years of age with a WHO emergency sign and a blood glucose concentration between 2.5 and 5.0 mmol/l, were randomised to receive either the WHO recommended treatment for hypoglycemia (intravenous dextrose), or treatment as per standard protocol (no extra dextrose). The children were followed up daily until they were discharged.”
How can this new knowledge contribute to achieving better health for all?
“The WHO defined hypoglycaemia (<2.5mmol/l) is associated with a case fatality rate of up to 42 % among children admitted to hospital in low income countries. Several studies also show an increased mortality among children with ‘low glycemia’, in other words blood glucose concentrations above the WHO defined cut-off for hypoglycemia but still low for a severe condition. Both hypoglycemia and ‘low glycemia’ in severe paediatric illness are associated with increased mortality risks.”
Our findings highlight the limited benefit of intravenous dextrose treatment alone and emphasizes the need to better understand the reasons for low blood glucose concentrations in this group to optimize management.”
The study was carried out in collaboration with College of Medicine, University of Malawi, Malawi and was funded by the Swedish Research Council.
Publication
Effect on mortality of increasing the cutoff blood glucose concentration for initiating hypoglycaemia treatment in severely sick children aged 1 month to 5 years in Malawi (SugarFACT): a pragmatic, randomised controlled trial.
Baker T, Ngwalangwa F, Masanjala H, Dube Q, Langton J, Marrone G, Hildenwall H.
Lancet Glob Health 2020 Oct;():