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Persistent burden and management gaps of hypoglycemia in pediatric type 1 diabetes: insights from the Epi-GLUREDIA

Maude Beckers1, Antoine Harvengt1, Gaetan de Valensart Schoenmaeckers2

  • 1Specialized Pediatrics Service, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium; UCLouvain, Institut de Recherche Expérimentale et Clinique, EDIN laboratory, Avenue Hippocrate 55, 1200 Brussels, Belgium.

Diabetes & Metabolism
|June 10, 2026
PubMed

Insights

Hypoglycemia is a significant challenge in pediatric type 1 diabetes, impacting daily life despite technological advances. Management and awareness gaps persist, necessitating integrated strategies for improved safety and outcomes.

Area of Science:

  • Pediatric Endocrinology
  • Metabolic Disorders
  • Diabetes Technology

Background:

  • Hypoglycemia poses a persistent challenge in pediatric type 1 diabetes management, even with automated insulin delivery systems.
  • Understanding the real-world burden, awareness, and daily impact of hypoglycemia is crucial for improving patient care.

Purpose of the Study:

  • To characterize the burden, awareness, and daily-life impact of hypoglycemia and severe hypoglycemia (SH) in pediatric type 1 diabetes.
  • To identify gaps in the perception and management of hypoglycemia in clinical practice.

Main Methods:

  • A prospective, descriptive, multicenter study involving 232 participants across six centers in Belgium and Luxembourg.
  • Utilized the novel GLUREDIA questionnaire to assess hypoglycemia frequency, symptom severity, perceived thresholds, SH history, management, and behavioral adaptations.
  • Evaluated hypoglycemia awareness using items aligned with established Clarke score domains.

Main Results:

  • Over half of participants (55.9%) experienced weekly hypoglycemia with significant symptom severity impacting daily activities.
  • Severe hypoglycemia (SH) was reported by 45.7%, with nearly a third having no clear cause.
  • Management of SH, including glucagon use, was inconsistent, and post-SH adaptations like insulin dose reduction and increased sugar intake were common.

Conclusions:

  • Hypoglycemia remains highly prevalent and impactful in pediatric type 1 diabetes, often poorly anticipated.
  • Gaps in SH management, awareness, and post-event adaptations highlight the need for integrated strategies.
  • Improved education, behavioral support, technology optimization, and guideline implementation are essential for enhancing hypoglycemia safety and outcomes.
Abstract

Keywords:
Adolescents/ChildrenGlucagonHypoglycemiaHypoglycemia AwarenessPediatric DiabetesSevere HypoglycemiaType 1 Diabetes

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