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 an education programme (HyPOS) to treat hypoglycaemia problems in patients with type 1 diabetes.
BACKGROUND In a r and omized , prospect i ve multi-centre trial , the effect of a specific training programme ( HyPOS ) for patients with hypoglycaemia problems was compared with a control group ( CG ) , receiving a st and ardized education programme aim ing at avoidance of hypoglycaemia by optimization of insulin therapy . METHODS A total of 164 type 1 diabetes patients ( age 46.0 + /- 12.5 yrs , HbA(1c ) 7.3 + /- 1.0 % , 50 % male ) were r and omized .  Hypoglycaemia awareness was measured by the  hypoglycaemia awareness question naire ( HAQ ) and by a  visual analogue scale ( VAS ) . There were no baseline differences . RESULTS After a 6-month follow-up , hypoglycaemia awareness significantly improved in HyPOS compared to that in the CG ( Delta HAQ 0.7 [ 95 % CL 0.1 - 1.2 ] , p = 0.024 , Delta VAS 0.8 [ 95 % CL 0.2 - 1.2 ] , p = 0.015 ) . In HyPOS , the threshold for detection of low blood glucose ( Delta 0.2 mmol/L [ 95 % CL 0.03 - 0.04 ] , p = 0.02 ) and the treatment of low blood glucose ( Delta 4.6 g [ 95 % CL 1.6 - 7.6 ] , p = 0.03 ) increased significantly . The number of undetected hypogylcaemic episodes ( Delta - 1.4 episodes per week [ 95 % CL 0.4 - 2.5 ] , p = 0.01 ) and the rate of mild hypoglycaemia dropped significantly in HyPOS ( Delta 2.1 % [ 95 % CL 0.5 - 5.3 ] , p = 0.015 ) . The numbers of severe ( Delta 0.3 events per patient per year [ 95 % CL - 0.04 - 1.0 ] , p = 0.037 ) and very severe hypoglycaemic episodes ( Delta 0.3 events per patient per year [ 95 % CL - 0.1 - 0.7 ] , p = 0.09 ) were lower in HyPOS , but these differences were not significant . CONCLUSION Compared to the CG , HyPOS demonstrates additional benefits in terms of improving impaired hypoglycaemia awareness , reducing mild hypoglycaemia , detecting low blood glucose , and treating low blood glucose
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 .