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 .
Assessment of the severity of hypoglycemia and glycemic lability in type 1 diabetic subjects undergoing islet transplantation.
Currently , the major indications for solitary islet transplantation are recurrent severe hypoglycemia and labile glucose control . Quantifying these problems remains subjective . We have developed a scoring system for both hypoglycemia and glycemic lability , established normative data , and used them in patients who have undergone islet transplantation .  A composite hypoglycemic score ( HYPO score ) was devised based on the frequency , severity , and degree of unawareness of the hypoglycemia . In addition , using 4 weeks of glucose records , a lability index ( LI ) was calculated based on the change in glucose levels over time and compared with a clinical assessment of glycemic lability . A mean amplitude of glycemic excursions ( MAGE ) was also calculated based on 2 consecutive days of seven readings each day . These scores were determined in 100 r and omly selected subjects with type 1 diabetes from our general clinic to serve as a control group and in patients before and after islet transplantation . The mean age of the control diabetic subjects was 38.4 + /- 1.3 years ( + /-SE ) , with a duration of diabetes of 21.5 + /- 1.1 years . The median HYPO score in the control subjects was 143 ( 25th to 75th interquartile range : 46 - 423 ) . The LI in the diabetic control subjects was 223 ( 25th to 75th interquartile range : 130 - 329 mmol/l(2)/h.week(-1 ) ) . The LI correlated much more closely than the MAGE with the clinical assessment of lability . A HYPO score of > or = 1,047 ( 90th percentile ) or an LI > or = 433 mmol/l(2)/h.week(-1 ) ( 90th percentile ) indicated serious problems with hypoglycemia or glycemic lability , respectively . The islet transplant patients ( n = 51 ) were 42.1 + /- 1.4 years old , with a duration of diabetes of 25.7 + /- 1.4 years . Islet transplant patients had a mean HYPO score of 1,234 + /- 184 pretransplant , which was significantly higher than that of the control subjects ( P < 0.001 ) , which became negligible posttransplantation with the elimination of hypoglycemia . The median LI pretransplant was 497 mmol/l(2)/h.week(-1 ) ( 25th to 75th interquartile range : 330 - 692 ) , significantly higher than that of control subjects ( P < 0.001 ) , and fell to 40 ( 25th to 75th interquartile range : 14 - 83 ) within a month after the final transplant . In those who had lost graft function , the LI rose again . The HYPO score and LI provide measures of the extent of problems with hypoglycemia and glycemic lability , respectively , complement the clinical assessment of the problems with glucose control before islet transplantation , and will allow comparison of selection of subjects for transplants between centers
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 .