{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T16:12:19Z","timestamp":1765728739474,"version":"3.37.3"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2019,10,24]],"date-time":"2019-10-24T00:00:00Z","timestamp":1571875200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,10,24]],"date-time":"2019-10-24T00:00:00Z","timestamp":1571875200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Deanship of Scientific Research at Jordan University of Science and Technology","award":["20160268"],"award-info":[{"award-number":["20160268"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Endocr Disord"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n              <jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Hypoglycemia is a common complication of insulin therapy in patients with Type 1 Diabetes Mellitus (DM). Awareness of hypoglycemic symptoms helps patients to recognize hypoglycemia and initiate self-treatment. Impaired Awareness of Hypoglycemia (IAH) exposes patients to severe hypoglycemia, which could be associated with seizures and unconsciousness. This study aimed to assess IAH, frequency of hypoglycemia, severe hypoglycemia and intensity of hypoglycemic symptoms among children and adolescents with Type 1 DM in North of Jordan.<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Data were collected from 94 children and adolescents with Type 1 DM. Clarke\u2019s and Edinburgh surveys were used to assess IAH and individual symptoms of hypoglycemia, respectively. Frequency of hypoglycemia and other related information were obtained by self-reporting or from medical records.<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>16.0% of participants were having IAH, 66.0% of participants reported recurrent hypoglycemia (&gt;once\/month) and 18.0% of participants developed \u22651 severe hypoglycemia during the previous year. IAH was not associated with age, gender, duration of DM, HbA1c, insulin regimen, adherence to insulin or development of severe hypoglycemia (<jats:italic>p<\/jats:italic>-values&gt;\u20090.05). Instead, IAH was associated with frequency of hypoglycemia during the previous 6\u2009months (<jats:italic>p<\/jats:italic>-value&lt;\u20090.01). Hunger, tiredness, dizziness, drowsiness, inability to concentrate, trembling and weakness were the most common symptoms felt by participants when they develop hypoglycemia. Hunger was the only common symptom that was significantly higher in children compared to adolescent (<jats:italic>p<\/jats:italic>-value &lt;\u20090.01).<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>This study has reported low prevalence of IAH in children and adolescents with Type 1 DM in North of Jordan. IAH was more common in subjects with more frequent hypoglycemia.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12902-019-0441-9","type":"journal-article","created":{"date-parts":[[2019,10,25]],"date-time":"2019-10-25T17:06:33Z","timestamp":1572023193000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Impaired awareness of hypoglycemia in children and adolescents with type 1 diabetes mellitus in north of Jordan"],"prefix":"10.1186","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9490-0979","authenticated-orcid":false,"given":"Mohammad J.","family":"Alkhatatbeh","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nedaa A.","family":"Abdalqader","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad A. Y.","family":"Alqudah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2019,10,24]]},"reference":[{"issue":"1","key":"441_CR1","doi-asserted-by":"publisher","first-page":"R38","DOI":"10.1530\/EC-17-0347","volume":"7","author":"SA Paschou","year":"2018","unstructured":"Paschou SA, Papadopoulou-Marketou N, Chrousos GP, Kanaka-Gantenbein C. On type 1 diabetes mellitus pathogenesis. Endocr Connect. 2018;7(1):R38\u201346.","journal-title":"Endocr Connect"},{"issue":"Suppl 1","key":"441_CR2","first-page":"S126","volume":"41","author":"12.Children and Adolescents","year":"2018","unstructured":"12.Children and Adolescents. Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018;41(Suppl 1):S126\u201336.","journal-title":"Diabetes Care"},{"issue":"S2","key":"441_CR3","doi-asserted-by":"publisher","first-page":"S250","DOI":"10.1089\/dia.2018.0113","volume":"20","author":"RE Ratner","year":"2018","unstructured":"Ratner RE. Hypoglycemia: new definitions and regulatory implications. Diabetes Technol Ther. 2018;20(S2):S250\u20133.","journal-title":"Diabetes Technol Ther"},{"issue":"1","key":"441_CR4","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1186\/1687-9856-2012-19","volume":"2012","author":"KE Lehecka","year":"2012","unstructured":"Lehecka KE, Renukuntla VS, Heptulla RA. Insight into hypoglycemia in pediatric type 1 diabetes mellitus. Int J Pediatr Endocrinol. 2012;2012(1):19.","journal-title":"Int J Pediatr Endocrinol"},{"issue":"6","key":"441_CR5","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1089\/dia.2014.0097","volume":"16","author":"R Basu","year":"2014","unstructured":"Basu R, Johnson ML, Kudva YC, Basu A. Exercise, hypoglycemia, and type 1 diabetes. Diabetes Technol Ther. 2014;16(6):331\u20137.","journal-title":"Diabetes Technol Ther"},{"issue":"3","key":"441_CR6","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1016\/j.ecl.2010.05.003","volume":"39","author":"PE Cryer","year":"2010","unstructured":"Cryer PE. Hypoglycemia in type 1 diabetes mellitus. Endocrinol Metab Clin N Am. 2010;39(3):641\u201354.","journal-title":"Endocrinol Metab Clin N Am"},{"issue":"9","key":"441_CR7","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1007\/s11892-016-0771-1","volume":"16","author":"DE McGill","year":"2016","unstructured":"McGill DE, Levitsky LL. Management of Hypoglycemia in children and adolescents with type 1 diabetes mellitus. Curr Diab Rep. 2016;16(9):88.","journal-title":"Curr Diab Rep"},{"issue":"10","key":"441_CR8","doi-asserted-by":"publisher","first-page":"1802","DOI":"10.2337\/dc09-0541","volume":"32","author":"TT Ly","year":"2009","unstructured":"Ly TT, Gallego PH, Davis EA, Jones TW. Impaired awareness of hypoglycemia in a population-based sample of children and adolescents with type 1 diabetes. Diabetes Care. 2009;32(10):1802\u20136.","journal-title":"Diabetes Care"},{"issue":"3","key":"441_CR9","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1111\/pedi.12077","volume":"15","author":"AJ Graveling","year":"2014","unstructured":"Graveling AJ, Noyes KJ, Allerhand MH, Wright RJ, Bath LE, Deary IJ, Frier BM. Prevalence of impaired awareness of hypoglycemia and identification of predictive symptoms in children and adolescents with type 1 diabetes. Pediatr Diabetes. 2014;15(3):206\u201313.","journal-title":"Pediatr Diabetes"},{"issue":"3","key":"441_CR10","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1016\/j.jdiacomp.2016.11.013","volume":"31","author":"C Hendrieckx","year":"2017","unstructured":"Hendrieckx C, Hagger V, Jenkins A, Skinner TC, Pouwer F, Speight J. Severe hypoglycemia, impaired awareness of hypoglycemia, and self-monitoring in adults with type 1 diabetes: results from diabetes MILES-Australia. J Diabetes Complicat. 2017;31(3):577\u201382.","journal-title":"J Diabetes Complicat"},{"issue":"7","key":"441_CR11","doi-asserted-by":"publisher","first-page":"697","DOI":"10.2337\/diacare.17.7.697","volume":"17","author":"AE Gold","year":"1994","unstructured":"Gold AE, MacLeod KM, Frier BM. Frequency of severe hypoglycemia in patients with type I diabetes with impaired awareness of hypoglycemia. Diabetes Care. 1994;17(7):697\u2013703.","journal-title":"Diabetes Care"},{"issue":"10","key":"441_CR12","doi-asserted-by":"publisher","first-page":"2333","DOI":"10.2337\/db10-0103","volume":"59","author":"RJ McCrimmon","year":"2010","unstructured":"McCrimmon RJ, Sherwin RS. Hypoglycemia in type 1 diabetes. Diabetes. 2010;59(10):2333\u20139.","journal-title":"Diabetes"},{"issue":"23","key":"441_CR13","doi-asserted-by":"publisher","first-page":"1676","DOI":"10.1056\/NEJM199306103282306","volume":"328","author":"DM Nathan","year":"1993","unstructured":"Nathan DM. Long-term complications of diabetes mellitus. N Engl J Med. 1993;328(23):1676\u201385.","journal-title":"N Engl J Med"},{"issue":"1","key":"441_CR14","first-page":"42","volume":"19","author":"JE Bartlett","year":"2001","unstructured":"Bartlett JE, Kotrlik JW, Higgins CC. Organizational research: determining appropriate sample size in survey research. Inf Technol Learn Perform J. 2001;19(1):42\u201350.","journal-title":"Inf Technol Learn Perform J"},{"key":"441_CR15","doi-asserted-by":"crossref","unstructured":"Age limits and adolescents. Paediatr Child Health. 2003;8(9):577.","DOI":"10.1093\/pch\/8.9.577"},{"issue":"4","key":"441_CR16","doi-asserted-by":"publisher","first-page":"517","DOI":"10.2337\/diacare.18.4.517","volume":"18","author":"WL Clarke","year":"1995","unstructured":"Clarke WL, Cox DJ, Gonder-Frederick LA, Julian D, Schlundt D, Polonsky W. Reduced awareness of hypoglycemia in adults with IDDM. A prospective study of hypoglycemic frequency and associated symptoms. Diabetes Care. 1995;18(4):517\u201322.","journal-title":"Diabetes Care"},{"issue":"8","key":"441_CR17","doi-asserted-by":"publisher","first-page":"771","DOI":"10.1007\/BF00401150","volume":"36","author":"IJ Deary","year":"1993","unstructured":"Deary IJ, Hepburn DA, MacLeod KM, Frier BM. Partitioning the symptoms of hypoglycaemia using multi-sample confirmatory factor analysis. Diabetologia. 1993;36(8):771\u20137.","journal-title":"Diabetologia"},{"issue":"8","key":"441_CR18","doi-asserted-by":"publisher","first-page":"729","DOI":"10.1111\/pedi.12460","volume":"18","author":"MB Abraham","year":"2017","unstructured":"Abraham MB, Gallego PH, Brownlee WM, Smith GJ, Davis EA, Jones TW. Reduced prevalence of impaired awareness of hypoglycemia in a population-based clinic sample of youth with type 1 diabetes. Pediatr Diabetes. 2017;18(8):729\u201333.","journal-title":"Pediatr Diabetes"},{"issue":"6","key":"441_CR19","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1016\/j.jdiacomp.2009.07.006","volume":"24","author":"T Hoi-Hansen","year":"2010","unstructured":"Hoi-Hansen T, Pedersen-Bjergaard U, Thorsteinsson B. Classification of hypoglycemia awareness in people with type 1 diabetes in clinical practice. J Diabetes Complicat. 2010;24(6):392\u20137.","journal-title":"J Diabetes Complicat"},{"issue":"7","key":"441_CR20","doi-asserted-by":"publisher","first-page":"912","DOI":"10.4239\/wjd.v6.i7.912","volume":"6","author":"I Martin-Timon","year":"2015","unstructured":"Martin-Timon I, Del Canizo-Gomez FJ. Mechanisms of hypoglycemia unawareness and implications in diabetic patients. World J Diabetes. 2015;6(7):912\u201326.","journal-title":"World J Diabetes"},{"issue":"4","key":"441_CR21","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1016\/j.jcjd.2014.05.007","volume":"38","author":"A Amin","year":"2014","unstructured":"Amin A, Lau L, Crawford S, Edwards A, Pacaud D. Prospective assessment of hypoglycemia symptoms in children and adults with type 1 diabetes. Can J Diabetes. 2014;38(4):263\u20138.","journal-title":"Can J Diabetes"},{"issue":"5","key":"441_CR22","doi-asserted-by":"publisher","first-page":"819","DOI":"10.4103\/2230-8210.117219","volume":"17","author":"S Kalra","year":"2013","unstructured":"Kalra S, Mukherjee JJ, Venkataraman S, Bantwal G, Shaikh S, Saboo B, Das AK, Ramachandran A. Hypoglycemia: the neglected complication. Indian J Endocrinol Metab. 2013;17(5):819\u201334.","journal-title":"Indian J Endocrinol Metab"}],"container-title":["BMC Endocrine Disorders"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12902-019-0441-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12902-019-0441-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12902-019-0441-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,10,22]],"date-time":"2020-10-22T23:04:40Z","timestamp":1603407880000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcendocrdisord.biomedcentral.com\/articles\/10.1186\/s12902-019-0441-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,24]]},"references-count":22,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,12]]}},"alternative-id":["441"],"URL":"https:\/\/doi.org\/10.1186\/s12902-019-0441-9","relation":{},"ISSN":["1472-6823"],"issn-type":[{"type":"electronic","value":"1472-6823"}],"subject":[],"published":{"date-parts":[[2019,10,24]]},"assertion":[{"value":"3 October 2018","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 October 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 October 2019","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Ethical approval was obtained from the Institutional Research Board (IRB) of the Ministry of Health \/ Jordan before starting patients\u2019 recruitment (Reference code: MOH REC160136). Parents of participants were informed about the purpose of the study before signing the consent forms. The consent of participation included both collecting data from participants and their parents and analysis of their medical records. Participants\u2019 identities were excluded to maintain confidentiality.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"This manuscript does not contain personal information such as individual details, images or videos; so, consent for publication is not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"107"}}