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 .
Long-Term Follow-Up Evaluation of Blood Glucose Awareness Training
OBJECTIVE Blood glucose awareness training ( BGAT ) has been found effective in teaching individuals with insulin-requiring diabetes to improve their ability to better recognize blood glucose ( BG ) fluctuations . This study investigated whether subjects who underwent BGAT a mean of 4.9 years previously were superior to past control subjects in terms of their ability to recognize BG fluctuations , and whether past BGAT subjects had fewer automobile crashes and lost work days and better glycosylated hemoglobin than control subjects . Additionally , the beneficial effects of providing booster training to past BGAT subjects also was evaluated . RESEARCH DESIGN AND METHODS This study followed up 28 past BGAT subjects . Half of these subjects ( n = 14 ) received a simple booster-training program . Twelve previous control subjects also were evaluated . Booster subjects were given a BGAT diary to complete for 2 weeks before evaluation . Evaluation for all subjects included completion of a retrospective question naire on work and driving history , blood drawing for a glycosylated hemoglobin analysis , and having subjects estimate and measure their BG levels 50–80 times during a 3- to 4-week period during their daily routine . RESULTS At long-term follow-up , BGAT subjects had significantly fewer automobile crashes than control subjects . BGAT subjects receiving booster training were significantly more accurate at estimating their BG levels and were more aware of hypoglycemia . Post hoc analyses indicated that the ability to accurately estimate BG fluctuations correlated positively with follow-up glycosylated hemoglobin and the number of hypoglycemic and hyperglycemic symptoms participants demonstrated . Both BGAT and control subjects demonstrated significantly improved glycosylated hemoglobin relative to baseline measures . CONCLUSIONS These data suggest that BGAT has long-term benefits , which can be enhanced with booster training . Specifically , BGAT and simple booster training may result in reduction of severe hypoglycemic episodes and automobile crashes in the long term
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 .