Tackling hypoglycemia in children: teams, targets and technology

Abstract

On the occasion of the Somogyi Award lecture this review focusses on the current advances in tackling hypoglycemia in pediatric patients with type 1 diabetes providing evidence for the importance of multidisciplinary teams, ambitious glycemic targets and implementation of diabetes technology. Meal-related intensified insulin replacement with differential substitution of basal- and bolus insulin is the therapy of choice in the care of children and adolescents with type 1 diabetes. The use of insulin pumps and continuous glucose monitoring devices is increasing rapidly, with the type of insulin therapy (insulin pen or pump) depending on the age of the patients and family preference. Education appropriate to the age and current challenges is essential for the children's participation in everyday life as undisturbed as possible. New parameters like time in range and time below range suitable for identifying high glycemic variability as risk factor for severe hypoglycemia complement the HbA1c targets and the ambulatory glucose profile (AGP) in a shared decision making on therapeutic adjustments between the diabetes team and people with diabetes. Automated insulin delivery as a hybrid closed loop or dosing advice using artificial intelligence are becoming a clinical reality. However, diabetes education as a team approach, defining clear targets with outcomes evaluated in multinational registries like SWEET remain important for shaping the future of pediatric diabetology.