TY - JOUR
T1 - Recommendations for recognizing, risk stratifying, treating, and managing children and adolescents with hypoglycemia
AU - Zucchini, Stefano
AU - Tumini, Stefano
AU - Scaramuzza, Andrea Enzo
AU - Bonfanti, Riccardo
AU - Delvecchio, Maurizio
AU - Franceschi, Roberto
AU - Iafusco, Dario
AU - Lenzi, Lorenzo
AU - Mozzillo, Enza
AU - Passanisi, Stefano
AU - Piona, Claudia
AU - Rabbone, Ivana
AU - Rapini, Novella
AU - Rigamonti, Andrea
AU - Ripoli, Carlo
AU - Salzano, Giuseppina
AU - Savastio, Silvia
AU - Schiaffini, Riccardo
AU - Zanfardino, Angela
AU - Cherubini, Valentino
N1 - Publisher Copyright:
Copyright © 2024 Zucchini, Tumini, Scaramuzza, Bonfanti, Delvecchio, Franceschi, Iafusco, Lenzi, Mozzillo, Passanisi, Piona, Rabbone, Rapini, Rigamonti, Ripoli, Salzano, Savastio, Schiaffini, Zanfardino, Cherubini and Diabetes Study Group of the Italian Society for Pediatric Endocrinology and Diabetes.
PY - 2024
Y1 - 2024
N2 - There has been continuous progress in diabetes management over the last few decades, not least due to the widespread dissemination of continuous glucose monitoring (CGM) and automated insulin delivery systems. These technological advances have radically changed the daily lives of people living with diabetes, improving the quality of life of both children and their families. Despite this, hypoglycemia remains the primary side-effect of insulin therapy. Based on a systematic review of the available scientific evidence, this paper aims to provide evidence-based recommendations for recognizing, risk stratifying, treating, and managing patients with hypoglycemia. The objective of these recommendations is to unify the behavior of pediatric diabetologists with respect to the timely recognition and prevention of hypoglycemic episodes and the correct treatment of hypoglycemia, especially in patients using CGM or advanced hybrid closed-loop systems. All authors have long experience in the specialty and are members of the Italian Society of Pediatric Endocrinology and Diabetology. The goal of treating hypoglycemia is to raise blood glucose above 70 mg/dL (3.9 mmol/L) and to prevent further decreases. Oral glucose at a dose of 0.3 g/kg (0.1 g/kg for children using “smart pumps” or hybrid closed loop systems in automated mode) is the preferred treatment for the conscious individual with blood glucose <70 mg/dL (3.9 mmol/L), although any form of carbohydrate (e.g., sucrose, which consists of glucose and fructose, or honey, sugary soft drinks, or fruit juice) containing glucose may be used. Using automatic insulin delivery systems, the oral glucose dose can be decreased to 0.1 g/kg. Practical flow charts are included to aid clinical decision-making. Although representing the official position of the Italian Society of Pediatric Endocrinology and Diabetology (ISPED), these guidelines are applicable to the global audience and are especially pertinent in the era of CGM and other advanced technologies.
AB - There has been continuous progress in diabetes management over the last few decades, not least due to the widespread dissemination of continuous glucose monitoring (CGM) and automated insulin delivery systems. These technological advances have radically changed the daily lives of people living with diabetes, improving the quality of life of both children and their families. Despite this, hypoglycemia remains the primary side-effect of insulin therapy. Based on a systematic review of the available scientific evidence, this paper aims to provide evidence-based recommendations for recognizing, risk stratifying, treating, and managing patients with hypoglycemia. The objective of these recommendations is to unify the behavior of pediatric diabetologists with respect to the timely recognition and prevention of hypoglycemic episodes and the correct treatment of hypoglycemia, especially in patients using CGM or advanced hybrid closed-loop systems. All authors have long experience in the specialty and are members of the Italian Society of Pediatric Endocrinology and Diabetology. The goal of treating hypoglycemia is to raise blood glucose above 70 mg/dL (3.9 mmol/L) and to prevent further decreases. Oral glucose at a dose of 0.3 g/kg (0.1 g/kg for children using “smart pumps” or hybrid closed loop systems in automated mode) is the preferred treatment for the conscious individual with blood glucose <70 mg/dL (3.9 mmol/L), although any form of carbohydrate (e.g., sucrose, which consists of glucose and fructose, or honey, sugary soft drinks, or fruit juice) containing glucose may be used. Using automatic insulin delivery systems, the oral glucose dose can be decreased to 0.1 g/kg. Practical flow charts are included to aid clinical decision-making. Although representing the official position of the Italian Society of Pediatric Endocrinology and Diabetology (ISPED), these guidelines are applicable to the global audience and are especially pertinent in the era of CGM and other advanced technologies.
KW - adolescents
KW - automated insulin delivery
KW - children
KW - glucagon
KW - hypoglycemia
KW - oral glucose
KW - type 1 diabetes
UR - http://www.scopus.com/inward/record.url?scp=85196285365&partnerID=8YFLogxK
U2 - 10.3389/fendo.2024.1387537
DO - 10.3389/fendo.2024.1387537
M3 - Article
SN - 1664-2392
VL - 15
JO - Frontiers in Endocrinology
JF - Frontiers in Endocrinology
M1 - 1387537
ER -