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Recovery of hypoglycaemia awareness in T1D

Up to 25% of people with type 1 diabetes may have impaired awareness of hypoglycaemia, with some experiencing life-threatening severe hypoglycaemia. (We drew attention to this problem earlier this year.) The Hypo COMPASS study was a 24-week randomised trial conducted to see if targeted education to help people with type 1 diabetes avoid hypoglycaemia benefited those with impaired hypoglycaemic awareness, regardless of the technology they used, and the results were positive.

by Colin Kenny, GP, Dromore

There were 96 participants aged 18– 74 years in the Hypo COMPASS study, all of whom had impaired awareness of hypoglycaemia, as defined by a validated score. Their mean HbA1c was 66 mmol/mol (8.2%). All participants received a 2-hour education session involving four defined elements aimed at strict avoidance of biochemical hypoglycaemia (<3 mmol/L) while maintaining overall glycaemic control.

Individuals were randomised in a 2×2 factorial design to: insulin pump therapy using insulin aspart or multiple daily injections with insulin aspart and insulin glargine; and real-time continuous glucose monitoring or self-monitoring of blood glucose. Episodes of severe hypoglycaemia, defined as needing assistance for treatment, dropped from nine at baseline to one at 24 weeks, with the proportion of participants affected declining from 92% in the year prior to the trial to just 19% during the trial. From the results, it would appear that appropriate education of these individuals is the crucial intervention.

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