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 .
Restoration of Self-Awareness of Hypoglycemia in Adults With Long-Standing Type 1 Diabetes
OBJECTIVE Impaired awareness of hypoglycemia ( IAH ) and defective counterregulation significantly increase severe hypoglycemia risk in type 1 diabetes ( T1D ) . We evaluated restoration of IAH/defective counterregulation by a treatment strategy targeted at hypoglycemia avoidance in adults with T1D with IAH ( Gold score ≥4 ) participating in the U.K.-based multicenter HypoCOMPaSS r and omized controlled trial . RESEARCH DESIGN AND METHODS Eighteen subjects with T1D and IAH ( mean ± SD age 50 ± 9 years , T1D duration 35 ± 10 years , HbA1c 8.1 ± 1.0 % [ 65 ± 10.9 mmol/mol ] ) underwent stepped hyperinsulinemic-hypoglycemic clamp studies before and after a 6-month intervention . The intervention comprised the HypoCOMPaSS education tool in all and r and omized allocation , in a 2 × 2 factorial study design , to multiple daily insulin analog injections or continuous subcutaneous insulin infusion therapy and conventional glucose monitoring or real-time continuous glucose monitoring  . Symptoms , cognitive function , and counterregulatory hormones were measured at each glucose plateau ( 5.0 , 3.8 , 3.4 , 2.8 , and 2.4 mmol/L ) , with each step lasting 40 min with subjects kept blinded to their actual glucose value throughout clamp studies . RESULTS After intervention , glucose concentrations at which subjects first felt hypoglycemic increased ( mean ± SE from 2.6 ± 0.1 to 3.1 ± 0.2 mmol/L , P = 0.02 ) , and symptom and plasma metanephrine responses to hypoglycemia were higher ( median area under curve for symptoms , 580 [ interquartile range { IQR } 420–780 ] vs. 710 [ 460–1,260 ] , P = 0.02 ; metanephrine , 2,412 [ −3,026 to 7,279 ] vs. 5,180 [ −771 to 11,513 ] , P = 0.01 ) . Glycemic threshold for deterioration of cognitive function measured by four-choice reaction time was unchanged , while the color-word Stroop test showed a degree of adaptation . CONCLUSIONS Even in long-st and ing T1D , IAH and defective counterregulation may be improved by a clinical strategy aim ed at hypoglycemia avoidance
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 .