These were able to reduce SH and improve glycemic control , with greater benefit from the latter two techniques in improving IAH .
Technological interventions ( insulin pump therapy , continuous glucose monitoring , and sensor-augmented pump ) reduced SH , improved glycemic control , and restored awareness when used in combination with structured education and frequent contact .
This review provides evidence for the effectiveness of a stepped-care approach in the management of patients with IAH  , initially with structured diabetes education in flexible insulin therapy , which may incorporate psychotherapeutic and behavioral therapies , progressing to diabetes technology , incorporating sensors and insulin pumps , in those with persisting need
OBJECTIVE Impaired awareness of hypoglycemia ( IAH ) increases the risk of severe hypoglycemia ( SH ) sixfold and affects 30 % of adults with type 1 diabetes ( T1D ) .
This systematic review and meta- analysis looks at the educational , technological , and pharmacological interventions aim ed at restoring hypoglycemia awareness ( HA ) in adults with T1D .
Reduced Awareness of Hypoglycemia in Adults With IDDM: A prospective study of hypoglycemic frequency and associated symptoms
OBJECTIVE To prospect ively evaluate the frequency and severity of hypoglycemic episodes in IDDM subjects who declare themselves to have reduced awareness of hypoglycemia , to vali date their self- design ations in their natural environment , and to determine objective ly the presence or absence of autonomic and neuroglycopenic symptoms associated with their low blood glucose ( BG ) levels . RESEARCH DESIGN AND METHODS A total of 78 insulin-dependent diabetes mellitus ( IDDM ) subjects ( mean age 38.3 ± 9.2 years ; duration of diabetes 19.3 ± 10.4 years ) completed two sets of assessment s separated by 6 months . The assessment s included reports of frequency and severity of low BG , symptoms associated with low BG , and a  BG symptom/estimation trial using a h and -held computer ( HHC ) . Diaries of hypoglycemic episodes were kept for the intervening 6 months  . HbA1 levels were determined at each assessment . RESULTS Of the subjects , 39 declared themselves as having reduced awareness of hypoglycemia ( reduced-awareness subjects ) . There were no differences between these reduced-awareness subjects and aware subjects with regard to age , sex , disease duration , insulin dose , or HbA1 . During the HHC trials , reduced-awareness subjects were significantly less accurate in detecting BG < 3.9 mmol/l ( 33.2 ± 47 vs. 47.6 ± 50 % detection , P = 0.001 ) and had significantly fewer autonomic ( 0.41 ± 0.82 vs. 1.08 ± 1.22 , P = 0.006 , reduced-awareness vs. aware ) and neuroglycopenic ( 0.44 ± 0.85 vs. 1.18 ± 1.32 , P = 0.004 , reduced-awareness vs. aware ) symptoms per subject . Prospect i ve diary records revealed that reduced-awareness subjects experienced more moderate ( 351 vs. 238 , P = 0.026 ) and severe ( 50 vs. 17 , P = 0.0062 ) hypoglycemic events . The second assessment results were similar to the first and verified the reliability of the data . CONCLUSIONS IDDM subjects who believe they have reduced awareness of hypoglycemia are generally correct . They have a history of more moderate and severe hypoglycemia , are less accurate at detecting BG < 3.9 mmol/l , and prospect ively experience more moderate and severe hypoglycemia than do aware subjects . Neither disease duration nor level of glucose control explains their reduced awareness of hypoglycemia . Reduced-awareness individuals may benefit from interventions design ed to teach them to recognize all of their potential early warning symptoms
These were able to reduce SH and improve glycemic control , with greater benefit from the latter two techniques in improving IAH .
Technological interventions ( insulin pump therapy , continuous glucose monitoring , and sensor-augmented pump ) reduced SH , improved glycemic control , and restored awareness when used in combination with structured education and frequent contact .
This review provides evidence for the effectiveness of a stepped-care approach in the management of patients with IAH  , initially with structured diabetes education in flexible insulin therapy , which may incorporate psychotherapeutic and behavioral therapies , progressing to diabetes technology , incorporating sensors and insulin pumps , in those with persisting need
OBJECTIVE Impaired awareness of hypoglycemia ( IAH ) increases the risk of severe hypoglycemia ( SH ) sixfold and affects 30 % of adults with type 1 diabetes ( T1D ) .
This systematic review and meta- analysis looks at the educational , technological , and pharmacological interventions aim ed at restoring hypoglycemia awareness ( HA ) in adults with T1D .