Persistent burden and management gaps of hypoglycemia in pediatric type 1 diabetes: insights from the Epi-GLUREDIA Study - 16/06/26
Highlights |
• | Why did we undertake this study? Hypoglycemia remains a major but incompletely characterized burden in pediatric type 1 diabetes despite advances in diabetes technologies. |
• | What questions did we want to answer? We assessed, in real-world practice, the frequency, awareness, management, and daily-life impact of hypoglycemia and severe hypoglycemia. |
• | What did we find? Hypoglycemia is frequent in pediatric type 1 diabetes, with marked interindividual variability in symptom thresholds and predominantly cognitive and functional symptoms. Over one-third of participants identified hypoglycemia as their dominant disease burden. Severe hypoglycemia was often unexplained and inconsistently managed, with post-event behavioral adaptations that may adversely affect glycemic control. |
• | What are the implications? These findings identify persistent gaps in hypoglycemia awareness and care, supporting integrated strategies combining education, behavioral support, optimized technologies, and improved guideline implementation. |
Abstract |
Background/Objectives |
- Despite advances in automated insulin delivery, hypoglycemia remains a major challenge in pediatric type 1 diabetes. We aimed to characterize, in real-world practice, the burden, awareness, and daily-life impact of hypoglycemia and severe hypoglycemia (SH), and to identify gaps in perception and management.
Methods |
- We conducted a prospective, descriptive, multicenter study using the new GLUREDIA questionnaire, administered during routine pediatric diabetes visits across six centers in Belgium and Luxembourg. This structured, study-specific, semi-quantitative tool assessed hypoglycemia frequency, symptom severity, perceived glycemic thresholds, SH history and management, and post-SH behavioral adaptations. Hypoglycemia awareness was evaluated using items aligned with Clarke score domains.
Results |
- Among 232 participants, 55.9% reported hypoglycemia at least weekly, with moderate-to-high symptom severity. Cognitive and daily-life symptoms (impaired focus, fatigue, hunger, tremor) were reported by > 60% and interfered with activities. Hypoglycemia was identified as the dominant disease burden by 39.7% of participants. Hypoglycemia-related symptom burden remained substantial and was not fully explained by CGM-derived metrics. SH was reported by 45.7%, without clear cause in 29.1%. Recommended management, including glucagon use, was inconsistently applied, even in recurrent SH. Following SH, participants reported insulin dose reductions (27.4%), increased sugar intake (21.1%), and avoidance of physical activities (22.1%), as adaptations. The Epi-GLUREDIA questionnaire demonstrated promising discriminative ability against the Clarke score (AUC = 0.84), supporting its construct validity.
Conclusions |
- Despite advances in diabetes technology, hypoglycemia remains highly prevalent, impactful, and often poorly anticipated in pediatric type 1 diabetes. Gaps in SH management and hypoglycemia awareness, together with post-event adaptations, highlight the need for integrated strategies combining education, behavioral support, optimized use of technologies, and improved implementation of guidelines, including appropriate glucagon use, to improve hypoglycemia safety, recognition, and long-term outcomes in pediatric type 1 diabetes.
Summary |
Hypoglycemia remains frequent and impactful in pediatric type 1 diabetes, with variable symptom thresholds, unexplained severe hypoglycemia, management gaps, and post-event adaptations that may impair glycemic control.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Keywords : Adolescents/Children, Glucagon, Hypoglycemia, Hypoglycemia Awareness, Pediatric Diabetes, Severe Hypoglycemia, Type 1 Diabetes
Plan
Vol 52 - N° 4
Article 101774- juillet 2026 Retour au numéro
Article précédent
- Impact of high intensity physical activity compared to routine counseling on renal function decline in patients with type 2 diabetes at high risk for kidney disease - the ACTIDIANE randomized controlled trial
- Samy Hadjadj, Stéphanie Ragot, Lisa Durocher, Edith Bigot-Corbel, Laurence Kessler, Igor Tauveron, Tiphaine Vidal-Trecan, Pierre Jean Saulnier, Pierre Gourdy, Myriam Moret, Vincent Rigalleau, Sophie Borot, Pierre Henri Ducluzeau, Cécile Ciangura, Nicolas Paquot, Anne Vambergue, Nicolas Chevalier, Claire Carette, Arnaud Monier, Philip Böhme, Alfred Pernfornis, Bruno Verges, Pierre Morcel, Jean François Gautier, Jean-Michel Halimi, Patrick Henry, Michel Marre, André Scheen, Martine Duclos, Laurent Bosquet, Bertrand Cariou, ACTIDIANE study group
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