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 .
Blood glucose awareness training and epinephrine responses to hypoglycemia during intensive treatment in type 1 diabetes.
OBJECTIVE To determine the effect of blood glucose awareness training ( BGAT ) on epinephrine and symptom responses to hypoglycemia in patients with type 1 diabetes enrolled in an intensive diabetes treatment ( IDT ) program . RESEARCH DESIGN AND METHODS A total of 47 subjects with uncomplicated diabetes ( duration 9 + /- 3 years : HbA1c 9.0 + /- 1.2 % ; reference range 4 - 6 % ) enrolled in a 4-month outpatient IDT program were r and omized to classes in BGAT ( n = 25 ) ( BGAT group ) or cholesterol awareness ( n = 22 ) ( control group ) . Subjects underwent stepped hypoglycemic clamp studies before and at completion of IDT . Plasma glucose was lowered from 6.7 mmol/l ( baseline ) to 4.4 , 3.9 , 3.3 , 2.8 , and 2.2 mmol/l over 190 min . Symptoms , counterregulatory hormones , and ability of the subject to estimate their glucose level were assessed at each plateau . At home , subjects used a h and held computer to first estimate and then measure and record blood glucose levels for 70 trials over a 4-week period immediately before IDT and again immediately following the educational intervention . RESULTS HbA1c decreased in both BGAT group ( 9.1 + /- 1.4 to 7.9 + /- 1.1 % ; P < 0.001 ) and control group ( 9.0 + /- 1.1 to 7.8 + /- 0.8 % ; P < 0.001 ) ( NS between groups ) . Frequency of hypoglycemia ( < 3.9 mmol/l ) increased in both groups , from 0.45 + /- 0.06 to 0.69 + /- 0.07 episodes per day ( P < 0.001 ) in the BGAT group and from 0.50 + /- 0.08 to 0.68 + /- 0.06 episodes per day ( P < 0.05 ) in the control group NS between groups ) . Epinephrine responses after IDT were greater in the BGAT group ( repeated measure analysis of variance [ ANOVA ] , F = 3.5 , P < 0.05 ) . A separate analysis of subjects n = 26 ) most at risk for hypoglycemia ( HbA1c after IDT < 7.8 % or an HbA1c improvement of > 2 percentage points ) showed that frequency of hypoglycemia increased in both the groups : from 0.50 + /- 0.09 to 0.80 + /- 0.11 episodes per day ( P < 0.01 ) in the BGAT group ( n = 14 ) and from 0.43 + /- 0.11 to 0.75 + /- 0.07 episodes per day ( P < 0.05 ) in the control group ( n = 12 ) ( NS between groups ) . However , the epinephrine response in control subjects decreased with IDT while the response in the BGAT subjects was preserved ( repeated measure ANOVA , F = 4.4 , P < 0.02 ) . CONCLUSIONS BGAT is a useful intervention to decrease blunting of counterregulatory responses associated with improved glycemic control and may modify the severity of hypoglycemia associated with improved glycemic control in type 1 diabetes
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 .