Among the many complications of type 1 diabetes (T1D), hypoglycemia is an acute concern for children with T1D and their families. Moreover, fear of hypoglycemia is a common barrier to achieving glucose targets. Numerous advances in care have been made since the Diabetes Control and Complications Trial was published in 1993 in which lower HbA1c was associated with increasing risk of severe hypoglycemia. More recent data indicate that lower HbA1c (7% ISPAD target) can be achieved without increasing the risk of severe hypoglycemia. Epidemiologic and clinical trial data will be reviewed to provide a historic and contemporary assessment of hypoglycemia in children with T1D. We are in the transition from blood glucose meters to continuous glucose monitors (CGM) and these improved tools for patients, families and clinicians can reduce the risk of hypoglycemia. Advances in insulin action, increased use of insulin pumps, and the advent of automated insulin delivery and their relationship to hypoglycemia will be discussed. Novel formulations of glucagon are in development and their clinical availability will add to our ability to prevent and treat hypoglycemia. These numerous advances have resulted in a beneficial impact on hypoglycemia in children with T1D. However, further advances are needed to improve care and reduce the burden of hypoglycemia on children with T1D and their families. Moreover, these advances must be made available to all children with T1D worldwide.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology