Objectives To develop and pilot a novel intervention addressing motivational and cognitive barriers to avoiding hypoglycemia in people with type 1 diabetes and persistent impaired awareness of hypoglycemia (IAH) despite training in flexible insulin therapy.
Research Design and Methods A 6-week intervention using motivational interviewing and cognitive behavioural techniques was designed. Diabetes educators were trained and supported in its delivery to 23 people with IAH (Gold score ≥4)
Results Twelve months post-course, hypoglycemia awareness had improved, (p<0.001). Median(range) rates of severe hypoglycemia fell from 3(0-104) to 0(0-3) per year, p<0.0001, moderate from 14(0-100) to 0(0-18) per 6 weeks, p<0.001). Worry and behaviour around hyperglycemia improved. HbA1c was unchanged.
Conclusion A pilot intervention targeting motivation and cognitions around hypoglycemia engaged patients with resistant IAH and recurrent severe hypoglycemia and was associated with significant improvement, supporting the hypothesis that these factors underpin problematic hypoglycemia.
- Received May 27, 2013.
- Accepted October 28, 2013.
- © 2013 by the American Diabetes Association.
Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.