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 recovery from unawareness, deficient counterregulation and lack of cognitive dysfunction during hypoglycaemia, following institution of rational, intensive insulin therapy in IDDM
Summary Hypoglycaemia unawareness , is a major risk factor for severe hypoglycaemia and a contraindication to the therapeutic goal of near-normoglycaemia in IDDM . We tested two hypotheses , first , that hypoglycaemia unawareness is reversible as long as hypoglycaemia is meticulously prevented by careful intensive insulin therapy in patients with short and long IDDM duration , and that such a result can be maintained long-term . Second , that intensive insulin therapy which strictly prevents hypoglycaemia , can maintain long-term near-normoglycaemia . We studied 21 IDDM patients with hypoglycaemia unawareness and frequent mild/severe hypoglycaemia episodes while on “ conventional ” insulin therapy , and 20 nondiabetic control subjects . Neuroendocrine and symptom responses , and deterioration in cognitive function were assessed in a stepped hypoglycaemia clamp before , and again after 2 weeks , 3 months and 1 year of either intensive insulin therapy which meticulously prevented hypoglycaemia ( based on physiologic insulin replacement and continuous education , experimental group , EXP , n=16 ) , or maintenance of the original “ conventional ” therapy ( control group , CON , n=5 ) . At entry to the study , all 21 IDDM- patients had subnormal neuroendocrine and symptom responses , and less deterioration of cognitive function during hypoglycaemia . After intensive insulin therapy in EXP , the frequency of hypoglycaemia decreased from 0.5±0.05 to 0.045±0.02 episodes/patient-day ; HbA1C increased from 5.83±0.18 to 6.94±0.13 % ( range in non-diabetic subjects 3.8–5.5 % ) over a 1-year period ; all counterregulatory hormone and symptom responses to hypoglycaemia improved between 2 weeks and 3 months , with the exception of glucagon which improved at 1 year ; and cognitive function deteriorated further as early as 2 weeks ( p<0.05 ) . The improvement in responses was maintained at 1 year . The improvement in plasma adrenaline and symptom responses inversely correlated with IDDM duration . In contrast , in CON , neither frequency of hypoglycaemia , nor neuroendocrine responses to hypoglycaemia improved . Thus , meticulous prevention of hypoglycaemia by intensive insulin therapy reverses hypoglycaemia unawareness even in patients with long-term IDDM , and is compatible with long-term near-normoglycaemia . Because carefully conducted intensive insulin therapy reduces , not increases the frequency of moderate/severe hypoglycaemia , intensive insulin therapy should be extended to the majority of IDDM patients in whom it is desirable to prevent/delay the onset/progression of microvascular complications
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 .