Knowledge, attitudes, and practices in pediatric hypoglycemia in Italy (KAPPHy study)

PURPOSE: Childhood hypoglycemia is associated with relevant morbidity and likely long-term neurological sequelae. Diagnostic thresholds and management strategies remain quite heterogeneous, particularly beyond the neonatal period. We aimed to evaluate current diagnostic and therapeutic practices for pediatric hypoglycemia management in Italy among members of the Italian Society of Pediatric Endocrinology and Diabetology (SIEDP) and the Italian Society of Metabolic Diseases and Newborn Screening (SIMMESN). METHODS: An anonymous electronic survey including 43 questions about management of pediatric hypoglycemia was sent to SIEDP and SIMMESN members. Descriptive statistics and comparative statistical analysis between respondents of the two societies were run. RESULTS: A total of 118 respondents participated. Most of them reported direct clinical experience in pediatric hypoglycemia and routinely used critical sampling during hypoglycemic episodes. Diagnostic thresholds were heterogeneous: 34.7% reported 50 mg/dL, 33.1% 60 mg/dL, and 22.0% 70 mg/dL. Comparative analysis between societies showed no differences in most diagnostic procedures, but significant differences emerged in diagnostic thresholds (p = 0.005), with SIMMESN members selected 60 mg/dL more frequently (adjusted p = 0.020), and SIEDP members more frequently 70 mg/dL (adjusted p = 0.013). SIMMESN members reported more frequent use of genetic testing for etiological diagnosis. SIEDP respondents showed a frequent used of continuous glucose monitoring in the follow-up. CONCLUSION: Management of pediatric hypoglycemia in Italy is largely aligned with international recommendations. Clinically relevant variability persists, particularly in diagnostic thresholds, adoption of molecular analysis, and technologies, likely reflecting different clinical focus and patient populations. Our findings highlight the need for harmonized national recommendations and shared diagnostic definitions across scientific societies.