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Cited by 78Diabetes Management and ResearchDiabetes Management and EducationDiabetes Treatment and Management

The role of structured education in the management of hypoglycaemia

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Iqbal, Ahmed, Heller, Simon R.·2018·Diabetologia
DOI 10.1007/s00125-017-4334-zPMC PMC6448987
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Abstract

The role of intensive glycaemic control in preventing microvascular disease in diabetes is well established. Iatrogenic hypoglycaemia is, however, a major barrier to effective treatment. Hypoglycaemia is associated with a significant level of morbidity and, despite pharmacological and technological therapeutic advances, reported rates of severe hypoglycaemia in clinical practice have not fallen over the last 20 years. This suggests that human factors are of major relevance and that ensuring the effective self-management of diabetes is an important strategy for the reduction of hypoglycaemic risk. Most of the evidence for the impact of this strategy on hypoglycaemia risk is confined to adults with type 1 diabetes although, in this review, we also cite studies that have specifically addressed this in type 2 diabetes. There are relatively few adequately powered RCTs that have rigorously evaluated the effectiveness of structured education and training programmes on hypoglycaemia; however, the available data suggest a subsequent reduction in severe hypoglycaemia rates of around 50%, a rate reduction that is comparable with that observed following technological interventions. Furthermore, longitudinal observational cohorts support these data, showing similar reductions in rates of hypoglycaemia following structured education. Those who continue to experience recurrent hypoglycaemia and impaired awareness of hypoglycaemia despite education and training in diabetes self-management may benefit from technological interventions and/or interventions that specifically address psychological factors that contribute to hypoglycaemia risk; however, there is urgent need for further research in this area. In the meantime, structured education for effective self-management of diabetes should be part of routine therapy for all those with type 1 diabetes.

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  • Structured education programs, such as DAFNE and BGAT, lead to sustained falls in level 3 hypoglycemia rates in those at high risk.

    “Structured education programs, such as Dose Adjustment For Normal Eating (DAFNE) and blood glucose awareness training (BGAT), which provide informed support for active insulin dose self-adjustment, are the key to the prevention of hypoglycemia and lead to sustained falls in level 3 hypoglycemia rates in those at high risk (122,123).”

    From The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) (2021) · cites this paper as [123]

    The DTTP-based programmes section reports about a 50% reduction in severe hypoglycaemia after DAFNE at one-year follow-up. The BGAT section and comparison table report a substantial reduction in a Swiss BGAT study followed for 12 months, where people with recurrent severe hypoglycaemia were encouraged to participate. However, the paper does not establish sustained reductions specifically in high-risk participants for both programmes: the DAFNE follow-up was not restricted to that group, and the Swiss BGAT study enrolled an unselected type 1 diabetes population. (LLM, conf=0.84)

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Authors
Iqbal, A., & Heller, S. R.
Affiliations
University of Sheffield (GB)
Corresponding author
Heller, Simon R.
ORCID
Venue
Diabetologia
Publisher
Springer Science and Business Media LLC
Published
2017-06-28
Volume
61
Issue
4
Pages
751-760
ISSN
  • 0012-186X (ISSN-L)
  • 1432-0428
DOI
10.1007/s00125-017-4334-z
PMC
PMC6448987
OpenAlex
W2732754780
Cited by
78
References
57
Citations by year
2026: 7 · 2025: 10 · 2024: 9 · 2023: 12 · 2022: 12 · 2021: 9 · 2020: 6 · 2019: 7 · 2018: 5
FWCI
3.89
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetologia (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
Funders
University of Sheffield
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
hypoglycemia, diabetes self-management education, structured education, type 1 diabetes, type 2 diabetes, severe hypoglycemia, hypoglycemia awareness, human factors, glycemic control, diabetes technology
MeSH terms
Awareness, Blood Glucose, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Feeding Behavior, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin, Patient Education as Topic, Self Care, Program Development

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