Table 3

Proposed clinical practice recommendations for the treatment of patients with T1D complicated by problematic hypoglycemia

1Routinely provide to all MDI therapy patients with T1D using SMBG structured and curriculum-based educational programs that reduce the incidence of SH and restore awareness in a significant proportion of patients with IAH.
2Add one diabetes technology, preferably CSII with SMBG or MDI with CGM, where available, with appropriate education, training, and support to patients with problematic hypoglycemia to reduce the incidence of SH and maintain or improve HbA1c.
3Use SAPs, preferably with an automated threshold-suspend feature, where available, or very frequent contact with a specialized hypoglycemia service in patients whose problematic hypoglycemia persists despite the use of structured education and other diabetes technologies.
4Consult with transplant program (and payer) about the eligibility of selected patients with persistent problematic hypoglycemia for an islet or a pancreas transplant when other interventions have not been effective and when the risk-benefit ratio is deemed favorable.