To evaluate the management and costs of severe hypoglycemia (SH) in children and adolescents with type 1 diabetes (T1D) in our Belgian tertiary pediatric care center. In the EPI-GLUREDIA study, clinical parameters from children and adolescents with T1D were retrospectively analyzed from July 2017 to June 2024. The characteristics of SH and its treatment were collected during the medical consultation following the SH episode. Between July 2017 and June 2024, 208 cases of SH were recorded in 113 children and adolescents with T1D, with an average age of 13.6 years and T1D duration of 6.2 years. Oral glucose was the most common treatment (47.4%), while glucagon was used in only 25.4% of cases and more frequently in boys (30.8%) than in girls (18.7%). Notably, only 43% of SH episodes were treated according to international guidelines. A significant increase in glucagon use was observed after reimbursement of its intranasal form in Belgium in January 2022. After 2022, glucagon use significantly increased (28/81 vs. 25/129
p = 0.013), particularly among teachers and educators (18/49 vs. 10/78
p = 0.002). The average direct cost of treating SH was €187.9, with costs ranging from €0 to €1092.5 depending on the treatment method.Conculusion: Our study underscores the difficulty in managing SH in young people with T1D, with only 43% being treated as per guidelines. Since 2022, the increased use of the intranasal form of glucagon in Belgium led to reduced healthcare costs and improved care of patients experiencing SH.