Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| Name | Class |
|---|---|
| Kamuzu University of Health Sciences | OTHER |
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
The purpose of this study is to evaluate the impact of dextrose administration in severely sick children admitted to hospital with low-glycaemia.
The problem: Mortality in children remains high in sub-Saharan African hospitals. While antimalarial drugs, antibiotics and other definitive treatments are well understood, the role of emergency care with supportive therapies such as maintaining normal glucose and electrolyte balances, has been given limited attention. Hypoglycaemia is common in children admitted to hospital in low-income settings. The current definition of hypoglycaemia is a blood glucose level of less than 2.5mmol/l. Outcomes for these children are poor, with a mortality rate of up to 42%. An increased mortality has also been reported among acutely ill children with low-glycaemia, defined as a blood glucose level of 2.5-5.0mmol/l. The reason for increased mortality rates is not fully understood.
Study objective: To determine the impact on mortality of a raised treatment cut-off level for paediatric hypoglycaemia, from 2.5mmol/l to 5.0mmol/l.
Methodology: Severely ill children admitted to two central Malawian hospitals; Queen Elisabeth Central Hospital, Blantyre and Zomba Central Hospital, with low-glycaemia (2.5-5.0mmol/l) will be randomised into intervention or control groups. The intervention group will be treated with an intravenous bolus of 10% dextrose 5ml/kg followed by a dextrose infusion in addition to standard care while the control group will receive standard care only. Children will be followed until discharge from hospital or death. Primary end-point is in-hospital mortality.
Enrolment started at Queen Elisabeth Central Hospital on Dec 5th 2016. Due to a slow enrolment rate a second site at Zomba Central Hospital has been opened to start enrolment on October 17th, 2017 in order for the project to be completed in December 2019.
Not provided
Not provided
Not provided
Not provided
| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Dextrose | Experimental | Children in the intervention group will immediately receive intravenous 5ml/kg 10% dextrose, Dextrose administration will continue as a maintenance infusion of intravenous 10% dextrose for 24 hours at standard maintenance rates. Capillary blood glucose monitoring will be repeated at 30 minute intervals with repeated equivalent bolus doses given until levels reach ≥5.0mmol/l. All children will be kept in the emergency department for a minimum of 60 minutes and have their vital signs checked at discharge from the emergency room to the ward. |
|
| Control | No Intervention | Usual care - the care that is currently provided in the hospital - will be provided. All children in the control group will be kept in the emergency department for a minimum of 60 minutes and have their vital signs checked at discharge from the emergency room to the ward. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| 10% dextrose | Drug | Bolus of 10% dextrose 5mls/kg |
|
| Measure | Description | Time Frame |
|---|---|---|
| In-hospital mortality in children 1 month to 5 years old | From date of randomization until the date of discharge from hospital or date of in-hospital death, whichever came first, assessed up to 12 months | Up to 12 months |
| Measure | Description | Time Frame |
|---|---|---|
| 24 hours mortality in children 1 month to 5 years old | Mortality within the first 24 hrs after admission | 24 hours after admission |
| Measure | Description | Time Frame |
|---|---|---|
| In-hospital mortality in children 5-12 years old | From date of randomization until the date of discharge from hospital or date of in-hospital death, whichever came first, assessed up to 12 months | Up to 12 months |
| In hospital mortality in children with initial hypoglycaemia (blood glucose <2.5mmol/l) and low glycemia after first dextrose bolus |
Inclusion Criteria:
Age between one month to 5 years (5 to 12 years for outcome measure no 3)
Parent/carer willing and able to give consent
Presence of one or several emergency signs (as defined in WHO pocket book of hospital care for children)
Clinical concern that the child is in an emergency state
Blood glucose 2.5-5.0mmol/l at arrival to the emergency department (3.0-5.0mmol/l for severely malnourished children). For outcome measure no 4 children with <2.5 mmol/l on arrival who then have 2.5-5.0 mmol/l on the repeat test 30 minutes later are also included
Exclusion Criteria:
Not provided
Not provided
Not provided
Not provided
Not provided
| Name | Affiliation | Role |
|---|---|---|
| Helena Hildenwall, MD, PhD | Karolinska Institutet | Principal Investigator |
| Tim Baker, MD, PhD | Karolinska Institutet | Principal Investigator |
| Queen Dube, MD, PhD | College of Medicine, Malawi | Principal Investigator |
| Josephine Langton, MD | College of Medicine, Malawi | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Queen Elisabeth Central Hospital | Blantyre | Malawi | ||||
| Zomba Central Hospital |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41776474 | Derived | Ngwalangwa F, Nyaika M, Baker T, Dube Q, Langton J, Hildenwall H. Mortality impact of an increased blood glucose cut-off level for hypoglycaemia treatment in severely sick children aged 5 to 12 years in Malawi - an exploratory randomised controlled study. BMC Pediatr. 2026 Mar 3;26(1):276. doi: 10.1186/s12887-026-06660-6. | |
| 33038950 |
Not provided
Not provided
| Type | Date | Date Unknown |
|---|---|---|
| Release | Oct 11, 2023 | |
| Reset | Apr 12, 2024 |
Not provided
Not provided
| Release Date | Unrelease Date | Unrelease Date Unknown | Reset Date | MCP Release Number |
|---|---|---|---|---|
| Oct 11, 2023 | Apr 12, 2024 |
| ID | Term |
|---|---|
| D004630 | Emergencies |
| D054198 | Precursor Cell Lymphoblastic Leukemia-Lymphoma |
| D016638 | Critical Illness |
| ID | Term |
|---|---|
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D007945 | Leukemia, Lymphoid |
Not provided
Not provided
| ID | Term |
|---|---|
| D005947 | Glucose |
| ID | Term |
|---|---|
| D006601 | Hexoses |
| D009005 | Monosaccharides |
| D000073893 | Sugars |
| D002241 | Carbohydrates |
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
From date of randomization until the date of discharge from hospital or date of in-hospital death, whichever came first, assessed up to 12 months |
| Up to 12 months |
| Zomba |
| Malawi |
| Baker T, Ngwalangwa F, Masanjala H, Dube Q, Langton J, Marrone G, Hildenwall H. 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. Lancet Glob Health. 2020 Dec;8(12):e1546-e1554. doi: 10.1016/S2214-109X(20)30388-0. Epub 2020 Oct 8. |
| 29325595 | Derived | Baker T, Dube Q, Langton J, Hildenwall H. Mortality impact of an increased blood glucose cut-off level for hypoglycaemia treatment in severely sick children in Malawi (SugarFACT trial): study protocol for a randomised controlled trial. Trials. 2018 Jan 11;19(1):33. doi: 10.1186/s13063-017-2411-8. |
| D007938 | Leukemia |
| D009370 | Neoplasms by Histologic Type |
| D009369 | Neoplasms |
| D006402 | Hematologic Diseases |
| D006425 | Hemic and Lymphatic Diseases |
| D008232 | Lymphoproliferative Disorders |
| D008206 | Lymphatic Diseases |
| D007160 | Immunoproliferative Disorders |
| D007154 | Immune System Diseases |