Long-term follow-up evaluation of blood glucose awareness training.
OBJECTIVE
Blood glucose awareness training (BGAT) has been found effective in teaching individuals with insulin-requiring diabetes to improve their ability to better recognize blood glucose (BG) fluctuations. This study investigated whether subjects who underwent BGAT a mean of 4.9 years previously were superior to past control subjects in terms of their ability to recognize BG fluctuations, and whether past BGAT subjects had fewer automobile crashes and lost work days and better glycosylated hemoglobin than control subjects. Additionally, the beneficial effects of providing booster training to past BGAT subjects also was evaluated.


METHODS
This study followed up 28 past BGAT subjects. Half of these subjects (n = 14) received a simple booster-training program. Twelve previous control subjects also were evaluated. Booster subjects were given a BGAT diary to complete for 2 weeks before evaluation. Evaluation for all subjects included completion of a retrospective questionnaire on work and driving history, blood drawing for a glycosylated hemoglobin analysis, and having subjects estimate and measure their BG levels 50-80 times during a 3- to 4-week period during their daily routine.


RESULTS
At long-term follow-up, BGAT subjects had significantly fewer automobile crashes than control subjects. BGAT subjects receiving booster training were significantly more accurate at estimating their BG levels and were more aware of hypoglycemia. Post hoc analyses indicated that the ability to accurately estimate BG fluctuations correlated positively with follow-up glycosylated hemoglobin and the number of hypoglycemic and hyperglycemic symptoms participants demonstrated. Both BGAT and control subjects demonstrated significantly improved glycosylated hemoglobin relative to baseline measures.


CONCLUSIONS
These data suggest that BGAT has long-term benefits, which can be enhanced with booster training. Specifically, BGAT and simple booster training may result in reduction of severe hypoglycemic episodes and automobile crashes in the long term.
Cox
D J
DJ
University of Virginia Health Sciences Center, Charlottesville 22901.
Gonder-Frederick
L
L
Julian
D M
DM
Clarke
W
W
D000063:Accidents, Traffic / Q000517:prevention & control*; D000328:Adult; D000704:Analysis of Variance; D001334:Automobile Driving; D001364:Awareness; D001786:Blood Glucose / Q000378:metabolism*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy / Q000534:rehabilitation*; D005500:Follow-Up Studies; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis / Q000517:prevention & control*; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use; D010353:Patient Education as Topic; D011795:Surveys and Questionnaires
D001786:Blood Glucose; D007328:Insulin