ISPAD Guidelines 2018 - Ch. 12: Assessment & management of hypoglycemia in children & adolescents

Chapter 12: Assessment and management of hypoglycemia in children and adolescents with diabetes

Mary B Abraham, Timothy W. Jones, Diana Naranjo, Beate Karges, Abiola Oduwole, Martin Tauschmann, David M. Maahs

Hypoglycemia continues to be a barrier impacting glycemic control with increase in psychosocial burden in children and adolescents living with Type 1 diabetes.

However, the rates of severe hypoglycemia have reduced worldwide with no association of severe hypoglycemia with improved glycemic control. The incidence of severe hypoglycemic coma has fallen over the last two decades with a current rate of 3 to 7 per 100 patient years across international registries. Although lower HbA1c was a risk factor for severe hypoglycemia, this association is no longer observed with contemporary therapy in recent surveys.

Although it is recognized that no single glucose level can define hypoglycemia in an individual, it is important to have accepted definitions to allow valid comparisons between models of care and therapies and the prospective evaluation of outcomes over time. In view of this, the definitions of hypoglycemia have been revised in accordance with the International Hypoglycemia Study Group to include relevant measures in the diabetes community to adopt a common approach to address the issue of hypoglycemic risk and include three levels of hypoglycemia; clinical hypoglycemia alert ≤3.9 mmol/L or 70 mg/dL to be used as the threshold value for identifying and treating to prevent hypoglycemia, clinically important or serious hypoglycemia with glucose <3.0 mmol/L (54 mg/dL) which indicates serious, clinically important hypoglycemia and severe hypoglycemia defined as an event associated with severe cognitive impairment (including coma and convulsions) requiring external assistance of another person to actively administer carbohydrates, glucagon, or take other corrective actions.

The chapter also dwells into measures used to identify patients at risk of hypoglycemia and management strategies to reduce and prevent the risk of hypoglycemia exposure with education and the availability of technological advancements which are designed to reduce and prevent hypoglycemia.

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