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 .
Use of continuous glucose monitoring system in the management of severe hypoglycemia.
BACKGROUND Severe hypoglycemia can have a dramatic impact on daily life for people with diabetes . Hypoglycemia is quantifiable by the HYPO-Score derived from the frequency of severe hypoglycemia over a year and a component based on 4 weeks of glucose records . The latter gives a modified HYPO-Score as a short-term measure of hypoglycemia . We used a continuous glucose monitoring system ( CGMS ) in patients with severe hypoglycemia to assess if we could decrease hypoglycemia as measured by the modified HYPO-Score . METHODS Sixteen type 1 diabetes subjects , 52.0 + /- 2.3 years old with a diabetes duration of 29.4 + /- 2.8 years having problematic hypoglycemia were enrolled . All used multiple daily insulin injections , and the glycosylated hemoglobin level was 8.4 + /- 0.3 % . After a month of gathering hypoglycemia information for baseline modified HYPO-Score , subjects wore the CGMS for 2 months , and a modified HYPO-Score was repeated . To assess long-term benefit , CGMS was then discontinued for 3 months , and a final modified HYPO-Score was determined . RESULTS The modified HYPO-Score decreased from 857 + /- 184 to 444 + /- 92 ( P = 0.055 ) ( intention-to-treat basis ) . Further analysis of the modified HYPO-Score when the CGMS was actually functioning showed it decreased from 857 + /- 184 to 366 + /- 86 ( P = 0.023 ) . Severe hypoglycemia episodes dropped from 16 at baseline to three when wearing the CGMS . The number of hypoglycemia episodes < 3.0 mmol/L dropped from 8.6 + /- 1.5 to 4.7 + /- 0.9 ( P = 0.01 ) . Subjects expressed less fear of hypoglycemia with CGMS . In 11 who completed modified Final Month HYPO-Scores , the number of severe hypoglycemic events rose to six . At study end , 13 of 16 subjects elected to continue using the CGMS . CONCLUSIONS When the CGMS was worn and functioning there was a significant decrease in the modified HYPO-Score and number of hypoglycemic values < 3.0
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 .