By Colin Kenny, GP, Dromore
The investigators reviewed 43 studies and identified educational interventions that comprised structured diabetes education on flexible insulin therapy, including psychotherapeutic and behavioural techniques. These interventions were able to reduce hypoglycaemia and improve glycaemic control, with greater benefit from the latter two techniques in improving impaired awareness of hypoglycaemia (IAH). Technological interventions (insulin pump therapy, continuous glucose monitoring and sensor-augmented pump) reduced severe hypoglycaemia, improved glycaemic control, and restored awareness when used in combination with structured education and frequent patient contact.
The investigators also examined pharmacological studies, which included four insulin studies and one non-insulin study, although these had low background severe hypoglycaemia prevalence rates. This review provides evidence for the effectiveness of a stepped-care approach in the management of people with IAH, initially with structured diabetes education on flexible insulin therapy (which may incorporate psychotherapeutic and behavioural therapies), and possibly progressing to diabetes technology, incorporating sensors and insulin pumps, in those with persisting need.
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