A psychoeducational programme to restore hypoglycemia awareness: the DAFNE-HART pilot study
- Nicole de Zoysa, DClinPsy1,
- Helen Rogers, RGN2,
- Marietta Stadler, MD1,
- Carla Gianfrancesco, RD3,
- Susan Beveridge, RGN3,
- Emma Britneff1,
- Pratik Choudhary, MD1,
- Jackie Elliott, MD4,
- Simon Heller, FRCP4 and
- Stephanie A Amiel, FRCP1⇑
- 1Diabetes Research Group, King’s College London, Weston Education Centre, 10, Cutcombe Road, London SE5 9RJ, UK
- 2King’s College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
- 3Sheffield Teaching Hospitals NHS Trust, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK , and
- 4Sheffield University School of Medicine, Academic Unit of Diabetes, Endocrinology and Metabolism, Room EU38, E Floor, School of Medicine and Biomedical Sciences, Beech Hill Road, Sheffield S10 2RX, UK.
- Corresponding Author: Stephanie A Amiel, E-mail:
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.