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 .
The effect of a diabetes education programme (PRIMAS) for people with type 1 diabetes: results of a randomized trial.
OBJECTIVE In a r and omized , multi-centre trial , the efficacy of a self-management-oriented education programme ( PRIMAS ) for people with type 1 diabetes was compared with an established education programme as control group ( CG ) . Primary outcome was the effect on glycaemic control in a 6-month follow-up . Secondary outcomes were the impact on emotional aspects , self-management related aspects and hypoglycaemia problems . METHODS The study was conducted in an outpatient setting . 160 participants were r and omized . Baseline characteristics in PRIMAS and CG were similar ( age 45.1±13.5 vs. 45.9±13.1 years , p=.716 ; diabetes duration 18.8±12.3 vs. 19.8±13.4 years , p=.615 ; BMI 26.5±4.6 vs. 27.5±5.0kg/m(2 ) , p=.236 ; HbA1c 8.3±1.1 vs. 8.1±1.0 % , p=.236 ) . RESULTS At follow-up there was a significant 0.4 percentage points greater reduction of HbA1c in PRIMAS compared to CG ( Δ -0.4±1.0 % vs. Δ 0.0±0.6 % ; p=.012 ) . Also , diabetes-related distress ( Δ -0.3±0.7 vs. -0.1±0.4 , p=.032 ) and dissatisfaction with diabetes treatment ( Δ -3.3±6.9 vs. -1.9±5.6 , p=.024 ) decreased more in PRIMAS . Diabetes empowerment ( Δ 2.6±5.9 vs. 0.8±5.1 , p=.037 ) and diabetes self-efficacy ( Δ 1.4±3.6 vs. 0.2±4.0 , p=.013 ) increased in PRIMAS . Incidence of severe hypoglycemia , hypoglycemia awareness , diabetes knowledge , and self-care behaviour improved in both groups with no significant differences between groups . CONCLUSION PRIMAS is more effective in lowering HbA1c than a previously established education programmes and also showed superiority in reducing diabetes-related distress and increasing diabetes empowerment , diabetes self-efficacy and satisfaction with insulin therapy
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 .