Volume 92, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Improving the availability of point-of-care (POC) diagnostics for glucose is crucial in resource-constrained settings (RCS). Both hypo and hyperglycemia have an appreciable frequency in the tropics and have been associated with increased risk of deaths in pediatrics units. However, causes of dysglycemia, including hyperglycemia, are numerous and insufficiently documented in RCS. Effective glycemic control with glucose infusion and/or intensive insulin therapy can improve clinical outcomes in western settings. A non-invasive way for insulin administration is not yet available for hyperglycemia. We documented a few causes and developed simple POC treatment of hypoglycemia in RCS. We showed the efficacy of sublingual sugar in two clinical trials. Dextrose gel has been recently tested for neonate mortality. This represents an interesting alternative that should be compared with sublingual sugar in RCS. New studies had to be done to document dysglycemia mechanism, frequency and morbid-mortality, and safe POC treatment in the tropics.


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  1. Hawkes M, Conroy AL, Opoka RO, Namasopo S, Liles WC, John CC, Kain KC, , 2014. Performance of point-of-care diagnostics for glucose, lactate, and hemoglobin in the management of severe malaria in a resource-constrained hospital in Uganda. Am J Trop Med Hyg. 90: 605608.[Crossref]
  2. Sambany E, Pussard E, Rajaonarivo C, Raobijaona H, Barennes H, , 2013. Childhood dysglycemia: prevalence and outcome in a referral hospital. PLoS ONE 8: e65193.[Crossref]
  3. Zijlmans WC, van Kempen AA, Serlie MJ, Kager PA, Sauerwein HP, , 2014. Adaptation of glucose metabolism to fasting in young children with infectious diseases: a perspective. J Pediatr Endocrinol Metab 27: 513.[Crossref]
  4. Willcox ML, Forster M, Dicko MI, Graz B, Mayon-White R, Barennes H, , 2010. Blood glucose and prognosis in children with presumed severe malaria: is there a threshold for ‘hypoglycemia?’ Trop Med Int Health 15: 232240.[Crossref]
  5. Patki VK, Chougule SB, , 2014. Hyperglycemia in critically ill children. Indian J Crit Care Med 18: 813.[Crossref]
  6. Bhutia TD, Lodha R, Kabra SK, , 2013. Abnormalities in glucose homeostasis in critically ill children. Pediatr Crit Care Med 14: e16e25.[Crossref]
  7. Osier FH, Berkley JA, Ross A, Sanderson F, Mohammed S, Newton CR, , 2003. Abnormal blood glucose concentrations on admission to a rural Kenyan district hospital: prevalence and outcome. Arch Dis Child 88: 621625.[Crossref]
  8. McMillan DE, Geevarghese PJ, , 1979. Dietary cyanide and tropical malnutrition diabetes. Diabetes Care 2: 202208.[Crossref]
  9. Nadjm B, Mtove G, Amos B, Hildenwall H, Najjuka A, Mtei F, Todd J, Reyburn H, , 2013. Blood glucose as a predictor of mortality in children admitted to the hospital with febrile illness in Tanzania. Am J Trop Med Hyg 89: 232237.[Crossref]
  10. Marsh K, Forster D, Waruiru C, Mwangi I, Winstanley M, Marsh V, Newton C, Winstanley P, Warn P, Peshu N, , 1995. Indicators of life-threatening malaria in African children. N Engl J Med 332: 13991404.[Crossref]
  11. Tripathy R, Parida S, Das L, Mishra DP, Tripathy D, Das MC, Chen H, Maguire JH, Panigrahi P, , 2007. Clinical manifestations and predictors of severe malaria in Indian children. Pediatrics 120: e454e460.[Crossref]
  12. Idro R, Ndiritu M, Ogutu B, Mithwani S, Maitland K, Berkley J, Crawley J, Fegan G, Bauni E, Peshu N, Marsh K, Neville B, Newton C, , 2007. Burden, features, and outcome of neurological involvement in acute falciparum malaria in Kenyan children. JAMA 297: 22322240.[Crossref]
  13. Zijlmans WC, van Kempen AA, Serlie MJ, Sauerwein HP, , 2009. Glucose metabolism in children: influence of age, fasting, and infectious diseases. Metabolism 58: 13561365.[Crossref]
  14. Taylor TE, Molyneux ME, Wirima JJ, Fletcher KA, Morris K, , 1988. Blood glucose levels in Malawian children before and during the administration of intravenous quinine for severe falciparum malaria. N Engl J Med 319: 10401047.[Crossref]
  15. Ogetii GN, Akech S, Jemutai J, Boga M, Kivaya E, Fegan G, Maitland K, , 2010. Hypoglycemia in severe malaria, clinical associations and relationship to quinine dosage. BMC Infect Dis 10: 334.[Crossref]
  16. Meda HA, Diallo B, Buchet JP, Lison D, Barennes H, Ouangre A, Sanou M, Cousens S, Tall F, Van de Perre P, , 1999. Epidemic of fatal encephalopathy in preschool children in Burkina Faso and consumption of unripe ackee (Blighia sapida) fruit. Lancet 353: 536540.[Crossref]
  17. Barennes H, Valea I, Boudat AM, Idle JR, Nagot N, , 2004. Early glucose and methylene blue are effective against unripe ackee apple (Blighia sapida) poisoning in mice. Food Chem Toxicol 42: 809815.[Crossref]
  18. Zijlmans WC, van Kempen AA, Ackermans MT, de Metz J, Kager PA, Sauerwein HP, , 2008. Very young children with uncomplicated falciparum malaria have higher risk of hypoglycemia: a study from Suriname. Trop Med Int Health 13: 626634.[Crossref]
  19. Zijlmans WC, van Kempen AA, Tanck MW, Ackermans MT, Jitan J, Sauerwein HP, , 2013. Fasting predisposes to hypoglycemia in Surinamese children with severe pneumonia, and young children are more at risk. J Trop Pediatr 59: 106112.[Crossref]
  20. Singhal PK, Singh M, Paul VK, Deorari AK, Ghorpade MG, Malhotra A, , 1992. Neonatal hypoglycemia–clinical profile and glucose requirements. Indian Pediatr 29: 167171.
  21. National Neonatal Perinatal Database Network, 2004. Morbidity and mortality among outborn neonates at 10 tertiary care institutions in India during the year 2000. J Trop Pediatr 50: 170174.[Crossref]
  22. Pal DK, Manandhar DS, Rajbhandari S, Land JM, Patel N, de L Costello AM, , 2000. Neonatal hypoglycemia in Nepal 1. Prevalence and risk factors. Arch Dis Child Fetal Neonatal Ed 82: F46F51.[Crossref]
  23. Barennes H, Willcox ML, Graz B, Pussard E, , 2014. Sublingual sugar for infant hypoglycemia. Lancet 383: 1208.[Crossref]
  24. Barennes H, Valea I, Nagot N, Van de Perre P, Pussard E, , 2005. Sublingual sugar administration as an alternative to intravenous dextrose administration to correct hypoglycemia among children in the tropics. Pediatrics 116: e648e653.[Crossref]
  25. Graz B, Dicko M, Willcox ML, Lambert B, Falquet J, Forster M, Giani S, Diakite C, Dembele EM, Diallo D, Barennes H, , 2008. Sublingual sugar for hypoglycemia in children with severe malaria: a pilot clinical study. Malar J 7: 242.[Crossref]
  26. Harris DL, Weston PJ, Signal M, Chase JG, Harding JE, , 2013. Dextrose gel for neonatal hypoglycemia (the Sugar Babies Study): a randomized, double-blind, placebo-controlled trial. Lancet 382: 20772083.[Crossref]
  27. Harding JE, Harris DL, Weston PJ, Signal M, Chase G, , 2014. Sublingual sugar for infant hypoglycemia—Authors' reply. Lancet 383: 12081209.[Crossref]
  28. Brutsaert E, Carey M, Zonszein J, , 2014. The clinical impact of inpatient hypoglycemia. J Diabetes Complications 28: 565572.[Crossref]
  29. Grey NJ, Perdrizet GA, , 2004. Reduction of nosocomial infections in the surgical intensive-care unit by strict glycemic control. Endocr Pract 10 (Suppl 2): 4652.[Crossref]
  30. Wu Y, Pei J, Yang XD, Cheng ZD, Zhao YY, Xiang B, , 2013. Hyperglycemia and its association with clinical outcomes for patients in the pediatric intensive care unit after abdominal surgery. J Pediatr Surg 48: 801805.[Crossref]
  31. Verbruggen SC, Joosten KF, Castillo L, van Goudoever JB, , 2007. Insulin therapy in the pediatric intensive care unit. Clin Nutr 26: 677690.[Crossref]
  32. Verbruggen SC, Landzaat LJ, Reiss IK, van Goudoever JB, Joosten KF, , 2012. Efficacy and safety of a tight glucose control protocol in critically ill term neonates. Neonatology 101: 232238.[Crossref]
  33. Macrae D, Grieve R, Allen E, Sadique Z, Morris K, Pappachan J, Parslow R, Tasker RC, Elbourne D, CHiP Investigator; , 2014. A randomized trial of hyperglycemic control in pediatric intensive care. N Engl J Med 370: 107118.[Crossref]
  34. Tian W, Hu Q, Xu Y, Xu Y, , 2012. Effect of soybean-lecithin as an enhancer of buccal mucosa absorption of insulin. Biomed Mater Eng 22: 171178.
  35. Heinemann L, , 2010. New ways of insulin delivery. Int J Clin Pract Suppl (170): 2940.[Crossref]
  36. Heinemann L, Pfutzner A, Heise T, , 2001. Alternative routes of administration as an approach to improve insulin therapy: update on dermal, oral, nasal and pulmonary insulin delivery. Curr Pharm Des 7: 13271351.[Crossref]

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  • Received : 08 Apr 2014
  • Accepted : 17 Jul 2014

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