title: Hypoglycemia anticipation, awareness and treatment training (HAATT) reduces occurrence of severe hypoglycemia among adults with type 1 diabetes mellitus.
abstract: Severe hypoglycemia (SH) can be a significant problem for patients around the world with Type 1 Diabetes Mellitus (T1DM). To avoid SH, patients need to better manage, and reduce the occurrence of, preceding mild hypoglycemia. Hypoglycemia Anticipation, Awareness and Treatment Training (HAATT), developed in the United States specifically to address such issues, was evaluated at short- and long-term follow-up in a medically, economically and culturally different setting; Bulgaria. Sixty adults with T1DM and a history of recurrent SH (20 each from Sofia, Russe, and Varna, Bulgaria) were randomized to Self-Monitoring of Blood Glucose (SMBG) or SMBG+ HAATT. For 6 months before and 1 to 6 and 13 to 18 months after intervention, participants recorded occurrence of moderate, severe, and nocturnal hypoglycemia. For 1-month pre- and post-intervention, participants completed daily diaries concerning their diabetes management. Relative to SMBG, HAATT produced significant improvement in occurrence of low BG, moderate, severe, and nocturnal hypoglycemia, and detection and treatment of low BG (p values < .05 to < .001), with no compromise in metabolic control. At long-term follow-up, HAATT participants continued to have significantly fewer episodes of moderate and severe hypoglycemia. These findings suggest that a structured, specialized psycho-educational treatment program (HAATT) can be highly effective in managing hypoglycemia.
authors.affiliation: University of Virginia Health Sciences Center, Charlottesville, Virginia, USA. djc4f@virginia.edu
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Cox
authors.forename: Boris
authors.initials: B
authors.lastname: Kovatchev
authors.forename: Dragomir
authors.initials: D
authors.lastname: Koev
authors.forename: Lidia
authors.initials: L
authors.lastname: Koeva
authors.forename: Svetoslav
authors.initials: S
authors.lastname: Dachev
authors.forename: Dimitar
authors.initials: D
authors.lastname: Tcharaktchiev
authors.forename: Anastassia
authors.initials: A
authors.lastname: Protopopova
authors.forename: Linda
authors.initials: L
authors.lastname: Gonder-Frederick
authors.forename: William
authors.initials: W
authors.lastname: Clarke
mesh_terms: D000328:Adult; D015190:Blood Glucose Self-Monitoring; D002940:Circadian Rhythm; D003466:Cultural Characteristics; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology*; D008297:Male; D010353:Patient Education as Topic; D010465:Perception; D012008:Recurrence; D016896:Treatment Outcome