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 .
Effect of Automated Bio-Behavioral Feedback on the Control of Type 1 Diabetes
OBJECTIVE To test the effect of an automated system providing real-time estimates of HbA1c , glucose variability , and risk for hypoglycemia . RESEARCH DESIGN AND METHODS For 1 year , 120 adults with type 1 diabetes ( 69 female/51 male , age = 39.1 [ 14.3 ] years , duration of diabetes 20.3 [ 12.9 ] years , HbA1c = 8.0 [ 1.5 ] ) , performed self-monitoring of blood glucose ( SMBG ) and received feedback at three increasingly complex levels , each continuing for 3 months : level 1—routine SMBG ; level 2—adding estimated HbA1c , hypoglycemia risk , and glucose variability ; and level 3—adding estimates of symptoms potentially related to hypoglycemia . The subjects were r and omized to feedback sequences of either levels 1 - 2 - 3 or levels 2 - 3 - 1 . HbA1c , symptomatic hypoglycemia , and blood glucose awareness were evaluated at baseline and at the end of each level . RESULTS For all subjects , HbA1c was reduced from 8.0 to 7.6 from baseline to the end of study ( P = 0.001 ) . This effect was confined to subjects with baseline HbA1c > 8.0 ( from 9.3 to 8.5 , P < 0.001 ) . Incidence of symptomatic moderate/severe hypoglycemia was reduced from 5.72 to 3.74 episodes/person/month ( P = 0.019 ) , more prominently for subjects with a history of severe hypoglycemia ( from 7.20 to 4.00 episodes , P = 0.008 ) and for those who were hypoglycemia unaware ( from 6.44 to 3.71 episodes , P = 0.045 ) . The subjects ’ ratings of the feedback were positive , with up to 89 % approval of the provided features . CONCLUSIONS Feedback of SMBG data and summary SMBG-based measures result ed in improvement in average glycemic control and reduction in moderate/severe hypoglycemia . These effects were most prominent in subjects who were at highest risk at the baseline
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 .