ESPE Abstracts

Introduction: For diagnosis of syndrome of hypoglycemia unawareness is used Clarke and/or Gold questionnaire. Frequency of this syndrome in children with type 1 diabetes (T1D) and its association with parameters of metabolic control including the CGM data are not well characterised.

Aims and methods: The aim of our study was to find the prevalence of this syndrome in children with T1D (age 8-19 years) followed at our department. The positivity of Clarke and/or Gold questionnaire is established at the score ≥4. We assessed the association of Clarke/Gold positivity to CGM parameters obtained from 14 days: TIR, TBR and TAR. Further associations were made to the HbA1c, average CGM glucose (AG), standard deviation (SD) and coefficient of variation (CV). The statistic analyses were made with Kruskal-Wallis and chi-square tests.

Results: 203 children with T1D (52% male) filled out the Clarke and Gold questionnaires. Mean age at that time was 13,5±(11,3-5,6) years, diabetes duration 6,2±(3,5-8,5) years. 70% of children used insulin pumps and 30% insulin pens. Mean time of sensor use was 92,0±(89,0-95,0)%. Mean TIR was 76,0±(69,0-83,0)%, TBR 4,0±(2,0-7,0)% (TBR1 3,0±(1,0-5,0)%, TBR2 1,0±(0,0-2,0)%), TAR 18,0±(11,0-27,0)%. Mean HbA1c was 49,5±(44,0-56,0) mmol/mol, TDD of insulin 0,8±(0,7-0,9) IU/kg/day, BMI 20,3±(18,0-23,0) kg/m2, AG 7,65±(7,0-8,38) mmol/l, SD 2,8±(2,3-3,2) mmol/l and CV 35,5±(31,2-39,8) %. From the total of 203 children 54 (27%) have positive Clarke and 51 (25%) Gold score. Both questionnaires were positive for 25 (12%) of children. In the last year 4/203 (2%) children suffered severe hypoglycemia with unconsciousness, all of them had positive Clarke score and 2 had positive Gold score. Clarke positive patients were significantly longer time in TBR1 than Clarke negative ones (4% vs. 3%, P=0,049). Other assessed parameters were not significantly associated with the Clarke positivity including the HbA1c levels (48 mmol/mol vs. 50 mmol/mol, P=0,35). No significant correlation to assessed parameters was found within the Gold positive group.

Conclusion: Children with T1D diagnosed by Clarke score with syndrome of hypoglycemia unawareness spent longer time bellow range level 1 however, they did not differ in other parameters of glycemic compensation. Based on this, clinical contribution of the questionnaire might be lower than in adult population but it may help to identify patients in the risk of severe hypoglycemia.