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 sensor-augmented insulin pump therapy and automated insulin suspension vs standard insulin pump therapy on hypoglycemia in patients with type 1 diabetes: a randomized clinical trial.
IMPORTANCE Hypoglycemia is a critical obstacle to the care of patients with type 1 diabetes .  Sensor-augmented insulin pump with automated low-glucose insulin suspension has the potential to reduce the incidence of major hypoglycemic events . OBJECTIVE To determine the incidence of severe and moderate hypoglycemia with sensor-augmented pump with low-glucose suspension compared with st and ard insulin pump therapy . DESIGN , SETTING , AND PARTICIPANTS A r and omized clinical trial involving 95 patients with type 1 diabetes , recruited from December 2009 to January 2012 in Australia . INTERVENTIONS Patients were r and omized to insulin pump only or automated insulin suspension for 6 months . MAIN OUTCOMES AND MEASURES The primary outcome was the combined incidence of severe ( hypoglycemic seizure or coma ) and moderate hypoglycemia ( an event requiring assistance for treatment ) . In a subgroup , counterregulatory hormone responses to hypoglycemia were assessed using the hypoglycemic clamp technique . RESULTS Of the 95 patients r and omized , 49 were assigned to the st and ard-pump ( pump-only ) therapy and 46 to the low-glucose suspension group . The mean ( SD ) age was 18.6 ( 11.8 ) years ; duration of diabetes , 11.0 ( 8.9 ) years ; and duration of pump therapy , 4.1 ( 3.4 ) years . The baseline rate of severe and moderate hypoglycemic events in the pump-only group was 20.7 vs 129.6 events per 100 patient months in the low-glucose suspension group . After 6 months of treatment , the event rates decreased from 28 to 16 in the pump-only group vs 175 to 35 in the low-glucose suspension group . The adjusted incidence rate per 100 patient-months was 34.2 ( 95 % CI , 22.0 - 53.3 ) for the pump-only group vs 9.5 ( 95 % CI , 5.2 - 17.4 ) for the low-glucose suspension group . The incidence rate ratio was 3.6 ( 95 % CI , 1.7 - 7.5 ; P < .001 ) . There was no change in glycated hemoglobin in either group : mean , 7.4 ( 95 % CI , 7.2 - 7.6 ) to 7.4 ( 95 % CI , 7.2 - 7.7 ) in the pump-only group vs mean , 7.6 ( 95 % , CI , 7.4 - 7.9 ) to 7.5 ( 95 % CI , 7.3 - 7.7 ) in the low-glucose suspension group . Counterregulatory hormone responses to hypoglycemia were not changed . There were no episodes of diabetic ketoacidosis or hyperglycemia with ketosis . CONCLUSIONS AND RELEVANCE Sensor-augmented pump therapy with automated insulin suspension reduced the combined rate of severe and moderate hypoglycemia in patients with type 1 diabetes . TRIAL REGISTRATION anzctr.org.au Identifier : ACTRN12610000024044
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 .