title: A psychoeducational program to restore hypoglycemia awareness: the DAFNE-HART pilot study.
abstract: OBJECTIVE
  To develop and pilot a novel intervention addressing motivational and cognitive barriers to avoiding hypoglycemia in people with type 1 diabetes and persistent impaired awareness of hypoglycemia (IAH) despite training in flexible insulin therapy.
  
  
  METHODS
  A 6-week intervention using motivational interviewing and cognitive behavioral techniques was designed. Diabetes educators were trained and supported in its delivery to 23 people with IAH (Gold score ≥4).
  
  
  RESULTS
  Twelve months postcourse, hypoglycemia awareness had improved (P < 0.001). Median (range) rates of severe hypoglycemia (SH) fell from 3 (0-104) to 0 (0-3) per person per year (P < 0.0001) and moderate from 14 (0-100) to 0 (0-18) per person per 6 weeks (P < 0.001). Worry and behavior around hyperglycemia improved. HbA1c was unchanged.
  
  
  CONCLUSIONS
  A pilot intervention targeting motivation and cognitions around hypoglycemia engaged patients with resistant IAH and recurrent SH and was associated with significant improvement, supporting the hypothesis that these factors underpin problematic hypoglycemia.
authors: Corresponding author: Stephanie A. Amiel, stephanie.amiel@kcl.ac.uk.
authors: Nicole
authors: N
authors: de Zoysa
authors: Helen
authors: H
authors: Rogers
authors: Marietta
authors: M
authors: Stadler
authors: Carla
authors: C
authors: Gianfrancesco
authors: Susan
authors: S
authors: Beveridge
authors: Emma
authors: E
authors: Britneff
authors: Pratik
authors: P
authors: Choudhary
authors: Jackie
authors: J
authors: Elliott
authors: Simon
authors: S
authors: Heller
authors: Stephanie A
authors: SA
authors: Amiel
mesh_terms: D000328:Adult; D001007:Anxiety; D001364:Awareness; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003922:Diabetes Mellitus, Type 1 / Q000523:psychology / Q000628:therapy*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy; D007003:Hypoglycemia / Q000139:chemically induced / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing; D010353:Patient Education as Topic / Q000379:methods*; D010865:Pilot Projects
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin