Blood Glucose Awareness Training (BGAT-2)
- Daniel J. Cox, PHD1,
- Linda Gonder-Frederick, PHD1,
- William Polonsky, PHD2,
- David Schlundt, PHD3,
- Boris Kovatchev, PHD1 and
- William Clarke, MD1
- 1University of Virginia Health Sciences Center, Charlottesville, Virginia
- 2Joslin Diabetes Center, Boston
- 3the Psychology Department, Vanderbilt University
OBJECTIVE—Blood glucose awareness training (BGAT) has been shown to improve awareness of blood glucose (BG) fluctuations among adults with type 1 diabetes. This study investigates the long-term (12-month) benefits of BGAT-2.
RESEARCH DESIGN AND METHODS—A total of 73 adults with type 1 diabetes participated in a 6-month repeated baseline design with a 12-month follow-up. At 6 months and 1 month before BGAT-2 and at 1, 6, and 12 months after BGAT-2, subjects used a handheld computer for 50 trials and completed psychological tests. Throughout assessment, subjects completed diaries, recording occurrences of diabetic ketoacidosis, severe hypoglycemia, and motor vehicle violations. During follow-up, 50% of the subjects received booster training.
RESULTS—During the first and last halves of both the baseline period and the follow-up period, dependent variables were generally stable. However, from baseline to follow-up, BGAT-2 led to 1) improved detection of hypoglycemia and hyperglycemia; 2) improved judgment regarding when to lower high BG, raise low BG, and not drive while hypoglycemic; 3) reduction in occurrence of diabetic ketoacidosis, severe hypoglycemia, and motor vehicle violations; and 4) improvement in terms of worry about hypoglycemia, quality of life, and diabetes knowledge. Reduction in severe hypoglycemia was not associated with a worsening of metabolic control (HbA1). The presence or absence of booster training did not differentially affect these benefits.
CONCLUSION—BGAT has sustained broad-ranging benefits, independent of booster intervention.
- ANOVA, analysis of variance
- BDI, Beck Depression Inventory
- BG, blood glucose
- BGAT, blood glucose awareness training
- DKA, diabetic ketoacidosis
- EGA, Error Grid Analysis
- MANOVA, multiple analysis of variance
- SMBG, self-monitoring of blood glucose
Address correspondence and reprint requests to Daniel J. Cox, Behavioral Medicine Center, Box 223, University of Virginia Health Sciences Center, Charlottesville, VA 22908.
Received for publication 3 April 2000 and accepted in revised form 30 November 2000.
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