Introduction
Epidemiology of hypoglycaemia
Studies of severe hypoglycaemia in adults with diabetes
Structured education programmes in the clinical management of hypoglycaemia
The Diabetes Teaching and Treatment programme
DTTP-based programmes: ‘dose adjustment for normal eating’ and ‘Tayside insulin management’
Programmes focussing on improving hypoglycaemia awareness
Study | Educational intervention | Participants in study arms, n
| Age, years; diabetes duration, mean years ± SD | Inclusion of those with IAH | Inclusion of those with SH in the year before intervention | Impact on hypoglycaemia detection/awareness | Impact on SH incidence, % | HbA1c change pre- vs post-intervention, % (mmol/mol) | Duration of follow-up |
---|---|---|---|---|---|---|---|---|---|
Cox et al (1994) [39] | Long-term follow-up evaluation of individuals receiving BGAT in two separate previous studies | Total, 41; BGAT, 14; BGAT + booster training, 14; control, 13 | 42.9 ± 3.5; 16.3 ± 2.8 | Unselected inclusion of individuals with T1D; those with IAH not excluded | Yes | Hypoglycaemia (< 2.8 mmol/l) detection rate: BGAT, 50%; BGAT + booster, 85%; control, 43% (p < 0.02 control vs BGAT and BGAT + booster) | SH rate not reported | BGAT, 12.3 (110.9) vs 10.2 (88); control 11.4 (101.1)vs 9.9 (84.7) (NS) | 4.9 years |
Kinsley et al (1999) [36] | BGAT vs control group (cholesterol awareness) training | Total, 47; BGAT, 25; control, 22 | 34.8 ± 8; 9 ± 3 | Unselected inclusion of individuals with T1D, those with IAH not excluded | No | Increased adrenaline (epinephrine) response to hypoglycaemia in BGAT group (p < 0.05); increased frequency of hypoglycaemia (<3.9 mmol/l) in BGAT and control group (NS) | SH rate not reported | BGAT, 9.0 (74.9) vs 7.8 (61.7); control, 9.1 (76) vs 7.9 (62.8) (NS) | 4 months |
Cox et al (2004) [41] | HAATT (7-week psycho-educational intervention based on BGAT) vs control group (SMBG) | Total, 40; HAATT, 20; control, 20 | 38.1 ± 9.3; 13.9 ± 8.5 | Yes | Yes | Improved detection of hypoglycaemia (<3.9 mmol/l) in HAATT (p = 0.005): pre- vs post-intervention, 52% vs 70%; pre- vs post-control, 58% to 55% | Reduced SH in HAATT (p = 0.03): pre- vs post-intervention, 2.0 vs 0.4 episodes per person per year; pre- vs post-control, 1.8 vs 1.7 episodes per person per year | HAATT, 8.1 (65) vs 9.0 (74.9); control, 8.0 (63.9) vs 8.1 (65.0) (NS) | 18 months |
Schachinger et al (2005) [40] | BGAT (III) (Swiss study) vs control group | Total, 111; BGAT, 56; control, 55 | 46.4 ± 13.8; 22.9 ± 12.1 | Unselected inclusion of individuals with T1D, those with IAH not excluded | Yes | Improved detection of hypoglycaemia in BGAT (III) (p = 0.005): pre- vs post-intervention, 52.7% vs 65.2%; pre- vs post-control, 53.5% vs 48% | Reduced SH in BGATT (III) (p < 0.05): pre- vs post-intervention, 1.61 vs 0.33 episodes per person per year; pre- vs post-control, 1.76 vs 1.78 episodes per person per year | No change: mean 6.9 (51.9) in BGAT(III) and control group | 12 months |
Hermanns et al (2010) [43] | HyPOS intervention vs control group (standard education). Long-term follow-up of the original HyPOS intervention [42] | Total, 64; HyPOS, 84; control, 80 | 46 ± 12.5; 21.4 ± 10.9 | Yes | Yes | Not reported (in original study [39], improvement in the modified Gold score [0–10] [p = 0.015]; pre- vs post-HyPOS, 4.3 vs 6.1; pre- vs post-control, 4.3 vs 5.3) | Reduced SH in HyPOS (p = 0.04): HyPOS, 0.1 episodes per person per year vs control, 0.2 episodes per person per year | No change: mean 7.2 (55.2) in HyPOS and control group | 31 months |
Hermanns et al (2013) [45] | Novel PRIMAS intervention vs control group (undergoing DTTP) | Total, 160; PRIMAS, 81; control, 79 | 45.4 ± 13.6; 19.5 ± 13 | Unselected inclusion of individuals with T1D, those with IAH not excluded | Yes | Improvement in hypoglycaemia awareness according to modifiedClarke scorea in both groups (NS):pre- vs post-PRIMAS, 1.5 vs 1.2; pre- vs post-control, 1.8 vs 1.3 | Reduced SH in both PRIMAS and control groups (NS): pre- vs post-PRIMAS, 0.29 vs 0.06 episodes per person per year; pre- vs post-control, 0.31 to 0.01 episodes per person per year | Pre- vs post-PRIMAS, 8.3 (67.2) vs 7.9 (62.8); pre- vs post-control, 8.1% (65) (p = 0.012 between groups) | 6 months |