Prevention Of Severe Hypoglycaemia Research Articles

Current Management of Type 1 Diabetes in Children: Guideline-based Expert Opinions and Recommendations.

Successful management of type 1 diabetes (T1D) requires not only optimal glycemic outcomes, but also a holistic approach that encompasses all aspects of life and recommendations to address needs. Current goals include optimal glycaemic values, quality of life and life expectancy similar to peers, prevention of long-term complications, prevention of severe hypoglycaemia as much as possible, facilitation of glucose management, etc. International Society for Pediatric and Adolescent Diabetes (ISPAD) has been updating its guidelines for diabetes care every 4 years since 1995, covering more and more topics. For optimal metabolic outcomes, diabetes teams need to follow these current recommendations, adapt them to their clinical practice and provide guidance to people with type 1 diabetes/families. In this review, in the light of ISPAD 2018-2022 guidelines and clinical experiences, "10 Key Recommendations", emphasizing the importance of teamwork and the use of technology, current type 1 diabetes treatment is described for practical applications.

THU276 The Use of Continuous Glucose Monitors for Management of Postbariatric Hypoglycemia

Abstract Disclosure: S. Jani: None. S. Bao: None. Postprandial hypoglycemia is a known complication of bariatric surgery. Mixed meal tolerance test performed in these patients often revealed hypoglycemia 1-3 hours after meals. Recent clinical studies using continuous glucose monitors (CGM) have shown the incidence of postbariatric hypoglycemia is much higher than previously identified. In addition to diet modification and medication treatment, CGM has become a more popular and useful tool in managing severe cases. We present a case of using CGM to manage postbariatric hypoglycemia. A 47 year old female with prior history of class 3 obesity treated with sleeve gastrectomy presented with hypoglycemia 2.5 years after her bariatric surgery. She complained of headache, anxiety, dizziness, and fatigue during a routine clinic visit, two hours after consuming a carbohydrate rich meal with simple sugars. Blood glucose was obtained and revealed severe hypoglycemia (glucose 38 mg/dL). This prompted an urgent referral to endocrinology. Review of glucose trends revealed multiple instances of postprandial hypoglycemia. Further labs suggested a low likelihood for insulinoma with no fasting hypoglycemia and HA1C normal at 5.3%. Postprandial hyperinsulinemic hypoglycemia was suspected clinically. Dietary modification with multiple small meals consisting of high protein, fiber and complex carbohydrates was recommended. Additionally, she was started on Libre 2 CGM for monitoring and prevention of severe hypoglycemia. Review of her CGM data during follow up visit demonstrated very low incidence of hypoglycemia and absence of severe hypoglycemia. Over time with continued use of her CGM and low incidence of hypoglycemia, she did not require medical therapy. Postprandial hypoglycemia after bariatric surgery can be severe and lead to disabling neuroglycopenic symptoms. With increased utilization of bariatric surgery, these postoperative complications will likely become more prevalent. In a Swedish nationwide study, the prevalence of postbariatric hypoglycemia was close to 0.2% in a cohort of 5040 patients. However, a more recent prospective study with a two-year observation of 333 patients after bariatric surgery using 2-hour glucose tolerance test revealed much higher prevalence of severe postprandial hypoglycemia (25.6%). Hypoglycemia was highest after gastric bypass surgery (32.6%), followed by sleeve gastrectomy (22.6%). Currently, there is no official guideline on utilization of CGM in management of hypoglycemia in nondiabetic patients. This case highlights the role of CGM in managing postbariatric hypoglycemia. CGM provides continuous glucose data, trends and alerts that can be a critical tool for patients to monitor, anticipate and prevent hypoglycemic events. Additionally, the real time data provided by CGM’s can help clinicians identify high risk patients who may benefit from the addition of medications to treat hypoglycemia. Presentation: Thursday, June 15, 2023

252-OR: Continuous Glucose Monitoring in Patients with Post-bariatric Hypoglycemia Reduces Hypoglycemia and Glycemic Variability

Post-bariatric hypoglycemia (PBH) is an increasingly recognized complication of bariatric surgery, with prevalence of up to 36% after gastric bypass. Hypoglycemia typically follows postprandial glycemic spikes. Continuous glucose monitors (CGM) can alert patients to high or low sensor glucose (SG), allowing treatment and prevention of severe hypoglycemia. The aim of this study (NCT03353415) was to determine whether CGM, currently indicated only for diabetes, could reduce hypoglycemia in PBH. In an open label, nonrandomized, pre-post design, sensor glucose data were collected using Dexcom CGM in two sequential phases: (1) masked (no access to SG or alarms); and (2) unmasked (access to SG and alarms for low or rapidly declining SG). Data were available for paired analysis for 22 individuals with PBH (mean±SD age 51.1±13.0 yrs, 20F/2M, BMI 30.6±6.2 kg/m2, 82% with level 3 hypoglycemia and 100% with neuroglycopenia). Participants with PBH spent a lower percentage of time in hypoglycemia with unmasked vs masked CGM (<60 mg/dL, median [MAD]: 0.7 [0.8] vs 1.4 [1.7]%, p=0.03; <70 mg/dL: 2.9 [2.5] vs 4.7 [4.8]%, p=0.04), with similar trends overnight. Likewise, there was more time between 70-180 mg/dL (94.8 [3.9] vs 90.8 [5.2]%, p=0.004), and lower glycemic variability (mean amplitude of glycemic excursion: 74.0 [17.7] vs 79.6 [17.8] mg/dL, p=0.04) during unmasked wear. During the day (6:00 AM-11:59 PM), participants spent more time in normoglycemia with unmasked CGM (94.2 [4.8] vs 90.9 [6.2]%, p=0.005), largely due to reduced hyperglycemia (>180 mg/dL: 1.9 [2.2] vs 3.9 [3.6]%, p=0.02). Availability of real-time CGM data and alarms is associated with reductions in low SG, elevated SG, and glycemic variability. This suggests CGM helps patients detect hyperglycemic peaks and imminent hypoglycemia, allowing dietary modification and self-treatment to reduce hypoglycemia. CGM may thus improve safety in PBH, particularly for patients with hypoglycemia unawareness. Disclosure C.J.Cummings: None. A.Jiang: None. A.L.Sheehan: None. R.Ferraz-bannitz: None. A.Puleio: None. D.C.Simonson: Stock/Shareholder; Phase V Technologies, Inc., GI Windows. J.Dreyfuss: None. M.Patti: Consultant; MBX Biosciences, AstraZeneca, Hanmi Pharm. Co., Ltd., Other Relationship; Fractyl Health, Inc. Funding Diabetes Research Center (P30DK036836)

Гипогликемия – барьер в достижении гликемического контроля. Значимость самоконтроля гликемии

Hypoglycemia is a well-known factor, limiting the patient's ability to achieve adequate glycemic control, and capable of causing a number of car-diovascular diseases (CVDs). Recurrent hypoglycemia may result in severe, potentially fatal complication of diabetes mellitus (DM), the impaired hypoglycemia awareness, raising the risk of severe hypoglycemia up up to six times. Measuring blood glucose levels is a universally accepted com-ponent of glycemic control and one of the strategies for prevention of hypoglycemia, along with the structured patient education in DM manage-ment and the use of modern hypoglycemic medications. Prevention of severe hypoglycemia may be important for prevention of CVDs in patients with DM.

Treatment and prevention of severe hypoglycaemia in people with diabetes: Current and new formulations of glucagon.

Some therapies for diabetes increase the risk of hypoglycaemia, in particular all insulins and insulin secretagogues, including the glinides and sulfonylureas. Hypoglycaemia remains a major limiting factor to successful glycaemic management, despite the availability of prevention options such as insulin analogues, continuous glucose monitoring, insulin pumps, and dogs that have been trained to detect hypoglycaemia. Non‐severe (self‐treated) and severe (requiring assistance for recovery) hypoglycaemia rates are higher in people with type 1 diabetes, but those with insulin‐treated type 2 diabetes are also at risk. Education and regular review are essential between people with diabetes and their caregivers and healthcare professionals about symptoms, prevention and treatment. Awareness of the potential dangers of hypoglycaemia is fundamental to the optimal management of diabetes. When therapy is intensified to achieve glycaemic targets, it is important that people at risk of severe hypoglycaemia, and particularly their caregivers, have ready access to effective treatment for hypoglycaemia emergencies. The current and potential formulations of glucagon available for treatment of severe hypoglycaemia are reviewed.

Assessment of the effectiveness of long-term insulin pump therapy using a combined goal of HbA1c decrease and absence of severe hypoglycemia

ObjectiveLess than one third of patients with type 1 diabetes mellitus (T1DM) achieve the cut-off value proposed as good metabolic control by most guidelines, HbA1c <7 %. However, HbA1c reductions and prevention of severe hypoglycemia (SH) have shown clinically relevant benefits. The study objective therefore was to assess the effectiveness of continuous subcutaneous insulin infusion (CSII) therapy at 5 years of follow-up in a cohort of patients attending a specialized unit using HbA1c reduction and SH absence as combined goals. MethodsA retrospective, observational study on 178 patients with T1DM who started CSII treatment at Hospital Clinic of Barcelona between 2003 and 2008. HbA1c levels at baseline and after 5 years of treatment with CSII and presence or absence of SH were recorded. The combined variables calculated included: a) HbA1c reduction by ≥0.5 points and absence of SH in the last 2 years; b) HbA1c at 5 years <7.5 % and no SH in the last 2 years; c) HbA1c <8.5 % and no HG in the last 2 years; d) HbA1c reduction by ≥0.5 points and/or HbA1c <7.5 % at 5 years with no SH in the last 2 years of follow-up. ResultsTwenty-seven of the 178 patients were excluded due to loss to follow-up or CSII discontinuation. A total of 151 patients (aged 37.4 ± 10.5 years, 64 % women, diabetes duration of 19.2 ± 10.7 years) were therefore analyzed. The two main reasons for starting CSII were suboptimal metabolic control (SMC, 60.9 %) and severe hypoglycemia/hypoglycemia unawareness (25.5 %). HbA1c levels in total cohort and in patients with SMC were 8.0 ± 1.2 and 8.4 ± 1.1 at CSII start and 7.8 ± 1.2 and 8.0 ± 1.3 at 5 years of treatment (p = 0.104 and p = 0.016) respectively. In the overall cohort, 55.5 % of patients achieved at 5 years the combined goal of HbA1c <7.5 % and/or HbA1c reductions ≥ 0.5 % without SH. ConclusionsAfter 5 years of CSII therapy, more than half the patients achieved the combined goal of significant HbA1c reduction and absence of SH. Use of combined goals offers the opportunity to assess the effectiveness of T1DM treatment from a viewpoint closer to its clinical meaning.

Outcomes of people with severe hypoglycaemia requiring prehospital emergency medical services management: a prospective study.

The aim of this work was to investigate clinical outcomes following severe hypoglycaemia requiring prehospital emergency medical services (EMS) management. We carried out a prospective, observational study of adults with diabetes attended by prehospital EMS for management of severe hypoglycaemia between April 2016 and July 2017. Information on precipitants, hospitalisation, length of hospital stay and recurrence was collected at 1 and 3months following the episode of severe hypoglycaemia. Median and logistic regression models examined predictive factors. Five hundred and five adults (61% male, median age 67years) participated in the study. Fifty-two per cent had type 1 diabetes, 43% type 2 diabetes and 5% were unsure of their diabetes type. Following EMS management of the index episode of severe hypoglycaemia, 50.3% were transported to hospital. Of those transported, 41.3% were admitted to hospital for ongoing management (20.8% of all participants). The following factors predicted hospital admission: older age (OR 1.28 [95% CI 1.02, 1.60] per 10years), greater number of comorbidities (OR 1.27 [95% CI 1.08, 1.48] per morbidity), moderate-severe injury accompanying the hypoglycaemia (OR 5.24 [95% CI 1.07, 25.8] compared with nil-mild injury) and unknown cause of hypoglycaemia (OR 2.21 [95% CI 1.24, 3.94] compared with known cause). The median (interquartile range) length of hospital stay was 4 (2-7) days. During follow-up, recurrent severe hypoglycaemia attended by prehospital EMS was experienced by 10.7% of participants. Predictive factors of recurrent severe hypoglycaemia in 3months were decreased HbA1c (OR 1.97 [95% CI 1.27, 3.06] per 10mmol/mol decrease) and a greater number of antecedent severe hypoglycaemia episodes (OR 1.12 [95% CI 1.03, 1.23] per episode). Following an episode of severe hypoglycaemia managed by EMS, one-fifth of participants required hospital admission, more likely in those with advancing age, increasing comorbidities and injury and one-tenth required EMS again for severe hypoglycaemia in a 3month period, more likely in those with a greater number of antecedent episodes and lower HbA1c. Knowledge of these factors associated with admission and recurrence provides an opportunity for development of targeted strategies aimed at prevention of severe hypoglycaemia in those most vulnerable.

Evaluación de la efectividad de la terapia ISCI a largo plazo mediante el objetivo combinado de descenso de HbA1c y ausencia de hipoglucemia grave

ObjectiveLess than one third of patients with type 1 diabetes mellitus (T1DM) achieve the cut-off value proposed as good metabolic control by most guidelines, HbA1c<7%. However, HbA1c reductions and prevention of severe hypoglycemia (SH) have shown clinically relevant benefits. The study objective therefore was to assess the effectiveness of continuous subcutaneous insulin infusion (CSII) therapy at 5 years of follow-up in a cohort of patients attending a specialized unit using HbA1c reduction and abscence of SH as combined goals. MethodsA retrospective, observational study on 178 patients with T1DM who started CSII treatment at Hospital Clinic of Barcelona between 2003 and 2008. HbA1c levels at baseline and after 5 years of treatment with CSII and presence or absence of SH were recorded. The combined variables calculated included: a) HbA1c reduction by≥0.5 points and absence of SH in the last 2 years; b) HbA1c at 5 years<7.5% and no SH in the last 2 years; c) HbA1c<8.5% and no HG in the last 2 years, and d) HbA1c reduction by≥0.5 points and/or HbA1c<7.5% at 5 years with no SH in the last 2 years of follow-up. ResultsTwenty-seven of the 178 patients were excluded due to loss to follow-up or CSII discontinuation. A total of 151 patients (aged 37.4±10.5 years, 64% women, diabetes duration of 19.2±10.7 years) were therefore analyzed. The 2 main reasons for starting CSII were suboptimal metabolic control (60.9%) and severe hypoglycemia/hypoglycemia unawareness (28.5%). HbA1c levels in the total cohort and in patients with suboptimal metabolic control were 8.0±1.2 and 8.4±1.1% at CSII start and 7.8±1.2 and 8.0±1.3% at 5 years of treatment (P=.104 and P=.016) respectively. In the overall cohort, 55.5% of patients achieved at 5 years the combined goal of HbA1c<7.5% and/or HbA1c reductions≥0.5% without SH. ConclusionsAfter 5 years of CSII therapy, more than half of the patients achieved the combined goal of significant HbA1c reduction and absence of SH. The use of combined goals offers the opportunity to assess the effectiveness of T1DM treatment from a clinically more meaningful point of view.

Effectiveness of an evidence-based protocol for the control of stress-induced hyperglycaemia in critical care

AimTo assess the effectiveness of the implementation of a protocol for glycaemic control in critical care, in terms of maintenance of a pre-established target of blood glucose level, reduction of hyperglycaemia and prevention of severe hypoglycaemia. MethodProspective “pre-post” quasi-experimental study carried out in a general critical care unit. Adult patients treated with intravenous insulin were included. We recorded all glycaemic tests performed from November 2014 to August 2015 (pre-intervention) and from November 2015 to August 2016 (post-intervention). The intervention consisted of the implementation of an evidence-based glycaemic control protocol to achieve glycaemic levels in a range of 140–180mg/dl. Main variables analysed were: proportion of glycaemic tests in the target range, proportions of severe hypoglycaemia (under 40mg/dl) and hyperglycaemia over 200mg/dl. ResultsWe analysed 7864 glycaemic tests from 125 patients, 66 pre-intervention and 59 post-intervention. Average age was 66.24±13.99 years, 64% of patients were male. The proportion of tests within the target range was higher in the intervention group (38.82 vs. 44.34 p<.001). Only one case of severe hypoglycaemia was identified, which happened in the pre-intervention period. The rate of severe hyperglycaemia was lower in the post-intervention group (19.19 vs. 16.28 p=.001). ConclusionsOur experience shows that implementation of evidence-based interventions can improve glycaemic control during critical illness. We found higher glycaemia levels in the target range. The protocol proved useful in the prevention of severe hypoglycaemia. Nurse-led interventions based on clinical data improved health results in our patients.

Prevention and Management of Severe Hypoglycemia and Hypoglycemia Unawareness: Incorporating Sensor Technology.

In addition to assisting in achieving improved glucose control, continuous glucose monitoring (CGM) sensor technology may also aid in detection and prevention of hypoglycemia. In this paper, we report on the current scientific evidence on the effectiveness of this technology in the prevention of severe hypoglycemia and hypoglycemia unawareness. Recent studies have found that the integration of CGM with continuous subcutaneous insulin infusion (CSII) therapy, a system known as sensor-augmented pump (SAP) therapy, very significantly reduces the occurrence of these conditions by providing real-time glucose readings/trends and automatically suspending insulin infusion when glucose is low (LGS) or, even, before glucose is low but is predicted to soon be low (PLGS). Initial data indicate that even for patients with type 1 diabetes treated with multiple daily injections, real-time CGM alone has been found to reduce both severe hypoglycemia and hypoglycemia unawareness. Closed loop systems (artificial pancreas) comprised of CGM and CSII without patient intervention to adjust basal insulin, which automatically reduce, increase, and suspend insulin delivery, represent a potential new option that is moving toward becoming a reality in the near future. Sensor technology promises to continue to improve patients' lives not only by attaining glycemic control but also by reducing hypoglycemia, a goal best achieved in conjunction with structured individualized patient education.

Efectividad de un protocolo basado en la evidencia para el control de la hiperglucemia por estrés en cuidados intensivos

AimTo assess the effectiveness of the implementation of a protocol for glycaemic control in critical care, in terms of maintenance of a pre-established target of blood glucose level, reduction of hyperglycaemia and prevention of severe hypoglycaemia. MethodProspective “pre-post” quasi-experimental study carried out in a general critical care unit. Adult patients treated with intravenous insulin were included. We recorded all glycaemic tests performed from November 2014 to August 2015 (pre-intervention) and from November 2015 to August 2016 (post-intervention). The intervention consisted of the implementation of an evidence-based glycaemic control protocol to achieve glycaemic levels in a range of 140-180mg/dl. Main variables analysed were: proportion of glycaemic tests in the target range, proportions of severe hypoglycaemia (under 40mg/dl) and hyperglycaemia over 200mg/dl. ResultsWe analysed 7864 glycaemic tests from 125 patients, 66 pre-intervention and 59 post-intervention. Average age was 66.24±13.99 years, 64% of patients were male. The proportion of tests within the target range was higher in the intervention group (38.82 vs. 44.34 p<.001). Only one case of severe hypoglycaemia was identified, which happened in the pre-intervention period. The rate of severe hyperglycaemia was lower in the post-intervention group (19.19 vs. 16.28 p=.001). ConclusionsOur experience shows that implementation of evidence-based interventions can improve glycaemic control during critical illness. We found higher glycaemia levels in the target range. The protocol proved useful in the prevention of severe hypoglycaemia. Nurse-led interventions based on clinical data improved health results in our patients.

Exploration of glycaemic states in children with type 1 diabetes.

The prevention of severe hypoglycaemia is based in art on accurately anticipating its occurrence. The aim of the study was to analyse the effect of a feedback procedure on the glycaemic state of children with type 1 diabetes, aswell as the associated symptoms and estimated BGL. For 7 days, 17 participants performed both scheduled capillary blood tests, and an estimate and self-analysis whenever they thought that there were changes in their BGL. A total of 454 trials were analysed with a mean of 178 mg/dl (SD= 36.4). Only 5.1% of the estimates corresponded to hypoglycaemia states, 36.77% were in areas with clinically dangerous consequences and were more accurate when the BGL reached the levels of &lt;= 56 mg/dl and less accurate when it reached &gt;240 mg/dl. The children reported symptoms at random, made mistakes when linking them with the BGL and demanded opportunity feedback believing they were in state of hypoglycaemia, while being in hyperglycaemia. The BGL was highly variable, certain glycaemic profiles peaked, with a greater average of hypoglycaemia than in the children&rsquo;s usual daily surroundings and did not present a profile of reliable signs indicative of BGL. The tendency to underestimate values when glycaemia was in hyperglycaemic levels is confirmed.

Transplantation: current developments and future directions; The future of clinical islet transplantation as a cure for diabetes

Islet transplantation is now a therapeutic option for patients with unstable type 1 diabetes mellitus (T1DM) with hypoglycemic unawareness. The benefits of this treatment include improvement in metabolic control with normalization of A1c and prevention of severe hypoglycemia. Insulin independence and improved quality of life can be reproducibly obtained by transplanting adequate islet numbers. Current obstacles to the widespread application of beta-cell replacement therapies include limited islet availability and the need for chronic immunosuppression. The emergence of promising interventions may be of assistance in improving islet recovery and favoring engraftment of smaller islet masses with comparable or better efficacy. In the future, regenerative efforts will contribute to overcoming this limitation as well. Combining these approaches with the development of safe immune interventions to induce self tolerance or to induce the permanent acceptance of transplanted tissues will be necessary to achieve long-term success. The steady progress and promising results of recent clinical trials justifies a great optimism toward the widespread application of beta-cell replacement as a treatment of choice for patients with diabetes.

Continuous Glucose Monitoring Device for the Prevention of Severe Hypoglycemia

Continuous Glucose Monitoring Device for the Prevention of Severe Hypoglycemia

Allogeneic islet transplantation

Significant progress has been made in the field of β-cell replacement therapies by islet transplantation in patients with unstable Type 1 diabetes mellitus (T1DM). Recent clinical trials have shown that islet transplantation can reproducibly lead to insulin independence when adequate islet numbers are implanted. Benefits include improvement of glycemic control, prevention of severe hypoglycemia and amelioration of quality of life. Numerous challenges still limit this therapeutic option from becoming the treatment of choice for T1DM. The limitations are primarily associated with the low islet yield of human pancreas isolations and the need for chronic immunosuppressive therapies. Herein the authors present an overview of the historical progress of islet transplantation and outline the recent advances of the field. Cellular therapies offer the potential for a cure for patients with T1DM. The progress in β-cell replacement treatment by islet transplantation as well as those of emerging immune interventions for the restoration of self tolerance justify great optimism for years to come.

Overcoming the Challenges Now Limiting Islet Transplantation

Steady improvements in islet cell processing technology and immunosuppressive protocols have made pancreatic islet transplantation a clinical reality for the treatment of patients with Type 1 diabetes mellitus (T1DM). Recent trials are showing that improved glycemic metabolic control, prevention of severe hypoglycemia, and better quality of life can be reproducibly achieved after transplantation of allogeneic islets in patients with unstable T1DM. Despite these encouraging results, challenges ahead comprise obtaining adequate islet cells for transplant, enhancing islets engraftment, sustaining beta cell mass and function over time, and defining effective immune interventions, among others. In order to overcome the current hurdles to the widespread application of islet transplantation there is a need for implementation of integrated, sequential therapeutic approaches.

Evolution of a Diabetes Inpatient Safety Committee

To develop a multidisciplinary team, the Diabetes Inpatient Safety Committee (DPSC), to effectively address the many barriers to achieving glycemic control in the inpatient setting. The development, implementation, and successes of the DPSC are described. By focusing on prevention of severe hypoglycemia, the DPSC identified and addressed areas related to inpatient management that contributed to uncontrolled glucose levels. The introduction of a hypoglycemia treatment protocol was followed by the development of a standardized order set for use of sliding scale insulin, with the eventual introduction of an Insulin Order Set guiding the use of scheduled and correctional insulin. Protocols and guidelines addressing more specific areas of inpatient glycemic management (insulin pump therapy, perioperative management, diabetic ketoacidosis, intravenous insulin) also have been developed. The successes of the DPSC to date have been directly related to strong institutional support, the dedication of a multidisciplinary team to address specific areas of glycemic management, the programmed introduction of order sets in conjunction with structured educational programs that accompany each protocol, and the use of quality improvement measures to evaluate the safety and efficacy of these protocols. Effective committees such as this will be instrumental in preventing errors and maximizing euglycemia.

Persistent effects of a pedagogical device targeted at prevention of severe hypoglycaemia: A randomized, controlled study

To study the long-term use of self-study material in type 1 diabetes patient education targeted at the prevention of severe hypoglycaemia. Randomized 1:1:1 control study in three local hospitals. We studied 332 type 1 diabetes patients from the geographic population, aged 2.6-18.9 y at entry. The intervention group received a videotape and brochure in which interviewed patients, parents and medical experts reviewed in detail practical skills for self-control and treatment, with the aim of preventing severe hypoglycaemia. There were two control groups: one received a videotape and brochure with general diabetes information and the other only traditional treatment. Primary endpoints were severe hypoglycaemia needing assistance by another person and HbA1c. Dissemination, reading/viewing level, patients' attitudes and extra contact with caregivers were also investigated. At 24 mo, 249 subjects provided data. The yearly incidence of severe hypoglycaemia decreased at 24 mo from 42% to 25% (difference 17%, 95% CI 3-31, p = 0.0241) in the intervention group, but not in controls. HbA1c remained unchanged. Video use during months 13-24 was higher in the intervention group than in controls (p = 0.0477), ranging from 1-15 (median 2) times, among 37% of patients (months 1-12, 100%). Higher future use was anticipated for intervention material (p = 0.0003). Extra caregiver contact was related to severe hypoglycaemia (p = 0.0009). The cost of the material was <EUR 10 per patient. Mass-distributed pedagogical devices such as high-quality video programmes and brochures may reach high dissemination levels and, when targeted, contribute to the prevention of severe hypoglycaemia over a longer period of time, being a cost-effective complement to traditional care.

Prevention of severe hypoglycaemia in type I diabetes: a randomised controlled population study

Aims: To investigate use of targeted self study material in type I diabetes patient education regarding dissemination, perceived patient benefit, and prevention of severe hypoglycaemia. Methods: In a randomised 1:1:1...

Self‐study material to prevent severe hypoglycaemia in children and adolescents with type 1 diabetes. A prospective intervention study

AbstractThe aim of this study was to evaluate use of self‐study material in diabetes education aimed at prevention of severe hypoglycaemia. Targeted self‐study brochures (and video programs) regarding diabetes self‐care and prevention of severe hypoglycaemia were mailed to all patients in early 1997 (and in 1999): a geographic population of 122–139 intensively treated type 1 diabetes patients yearly, aged 1–18 years (mean 12.2, SD 4.3), between 1994 and 1999. Yearly mean HbA1c (1.15% below DCCT level) ranged from 4.1 to 11.6% (mean 6.6, SD 1.1), age at onset 0.5–17.4 years (mean 7.6, SD 4.0) and duration 0.1–16.6 years (mean 4.6, SD 3.7). Main outcomes were patient attitudes to the interventions, perceived benefit, level of use, severe hypoglycaemia, and HbA1c.Eighty‐six percent of responders stated that the video was valuable. Perceived benefit was higher for the hypoglycaemia prevention video than for the brochure (p = 0.016). Those with severe hypoglycaemia the preceding year indicated greater benefit from the hypoglycaemia prevention brochure than others (p = 0.039). Average yearly incidence of severe hypoglycaemia with unconsciousness decreased from 13% in 1994–1996 to 9% (ns) in 1997–1999. The per patient cost of the material was &lt;Euro 10.Conclusion. Self‐study material can reach high dissemination at a low cost. It also seems to have contributed to a decrease in severe hypoglycaemia, but controlled studies are needed. There is a great need for good quality patient/consumer information materials dealing with aspects of general management and risk prevention in diabetes treatment.The findings may have implications for other topics, ages, and diagnosis groups. Copyright © 2002 John Wiley &amp; Sons, Ltd.