Endocrine Abstracts

JOINT3355

Background: Hypoglycemia awareness is the ability to recognize when blood sugar is low, through the activation of counter-regulatory hormones and the perception of symptoms. It is a known fact that frequent hypoglycemic events can impair this awareness. Celiac disease increases the risk of hypoglycemia in type 1 diabetes (T1D). However, there is a lack of data in the literature regarding whether celiac disease leads to hypoglycemia unawareness in children with T1D. We aimed to investigate the possible effects of celiac disease on hypoglycemia awareness in pediatric patients with T1D.

Materials and Methods: This prospective cross-sectional study included children aged 5-18 years with T1D, who visited our clinic between November 2024 and January 2025. The participants were divided into two groups: one with both T1D and celiac disease, and another with T1D alone. The sample size was determined through a power analysis with a 3:1 case-to-control ratio. Hypoglycemia awareness was evaluated by the Clarke’s questionnaire, and participants’ knowledge about hypoglycemia management was noted. The results are presented as means (±standard deviation) or medians (25-75th percentile) depending on the distribution of the data.

Results: The study was conducted with 87 T1D patients (54% male, age 12. 5 ± 3. 5 years). The mean diabetes duration was 5. 1 (±3. 5) years, and the average HbA1c level was 8. 5% (±1. 8). The most common symptoms reported during hypoglycemic events were hand trembling (46. 5%), weakness (23. 3%), and dizziness (10. 5%). Celiac disease was present in 24. 4% (n = 21) of the participants, with a median disease duration of 3. 1 (1. 4 – 5. 3) years. No significant differences were found between the two groups in age, diabetes duration, HbA1c, or hypoglycemia knowledge (p>0. 05). Among the individuals with celiac disease, 19% (n = 4) had impaired hypoglycemia awareness, while 12% (n = 8) of those with only T1D had this issue. There was no significant difference between the two groups regarding hypoglycemia unawareness (P = 0. 476). Additionally, there were no significant differences in age, HbA1c levels, diabetes duration, or knowledge about hypoglycemia between patients with and without impaired hypoglycemia awareness (p>0. 05).

Conclusion: To our knowledge, this is the first study to show that celiac disease did not affect hypoglycemia awareness in children with T1D. We also found no correlation between HbA1c levels and hypoglycemia awareness. These findings suggested that while children with T1D and celiac disease, or those with poor metabolic control, may experience more frequent hypoglycemic events, the duration of hypoglycemia may be more critical in the development of hypoglycemia unawareness.