`Dead-in-bed' syndrome - a diabetes nightmare

Authors: Koltin, Dror; Daneman, Denis

Source: Pediatric Diabetes, Volume 9, Number 5, October 2008 , pp. 504-507(4)

Publisher: Wiley-Blackwell

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Abstract:

Koltin D, Daneman D. `Dead-in-bed' syndrome - a diabetes nightmare.

Pediatric Diabetes 2008: 9: 504-507. Abstract:

We report in this study the death in bed of a 14-yr-old girl with type 1 diabetes and a review of the existing literature on this topic. Diagnosed at 5 yr of age, the patient followed a relatively benign disease course. Hemoglobin A1c was 6.6-8.4%, and there were no hospital admissions apart from the one at diagnosis. Hypoglycemic episodes were not excessive or severe. At age 14 yr, the patient was found dead in bed after having been well the night before. No apparent explanation could be provided. The `dead-in-bed' syndrome accounts for 5-6% of mortality cases in patients with type 1 diabetes, amounting to two to six cases per 10 000 patient years. Theories attempting to explain the mechanism for this syndrome include hypoglycemia or cardiac autonomic dysfunction. This case emphasizes several problems faced by clinicians: the risk for sudden death in youth with diabetes, which may compromise good glycemic control, the question of early detection of autonomic dysfunction, and the need to understand this phenomenon better and search for preventive measures.

Keywords: autonomic dysfunction; diabetes mellitus; hypoglycemia; sudden death

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1399-5448.2008.00404.x

Affiliations: 1: Division of Endocrinology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

Publication date: 2008-10-01