Hypoglycaemia thresholds in children with Type 1 diabetes: real-life practices in the era of diabetes technology.

INTRODUCTION: With an increased use of diabetes technology in Type 1 diabetes, there is noted variability in the glucose thresholds at which hypoglycaemia is treated. The study therefore investigated the thresholds for hypoglycaemia treatment on contemporary treatment to capture real-life practices and compared the relationship between glycaemia, hypoglycaemia awareness (HA), and fear of hypoglycaemia (FOH) with their chosen treatment threshold. METHODS: Children with Type 1 diabetes (parent if child < 12 years) responded to an online survey reporting their chosen glucose thresholds. Clinical and glycaemic data were retrieved from the Western Australian Children's Diabetes Database. Participant groups were defined as treatment at, below and above the recommended threshold (RT) of less than 3.9 mmol/L. RESULTS: Of 271 respondents (median age 13.4 years, 98% CGM), 54% treated hypoglycaemia at RT, 25% treated above and 21% treated below. This adoption of glucose thresholds was independent of mode of insulin delivery (p=0.54). Participants also adjusted thresholds based on day/night (37.3%), presence of active insulin on board (56.1%) and exercise (83.8%), with 96.2% using CGM trend arrows to guide the need for treatment. There was no evidence of a difference in HbA1c, time in range, time below range (TBR), HA and FOH scores between the three groups (p>0.05), However, those treating above RT achieved target TBR <3.9 mmol/L (<4%) than other groups (p<0.05). Three episodes of severe hypoglycaemia occurred: one in the below-RT group and two in the RT group. CONCLUSION: Parents and children personalise the glucose thresholds for commencing hypoglycaemia treatment based on the clinical context. Although these thresholds did not increase the time in hypoglycaemia, further studies are needed to evaluate the safe adoption of this approach in clinical care.