Hypoglycaemia in type 1 diabetes: technological treatments, their limitations and the place of psychology
Open accessAbstract
Advances in technology allowing improved insulin delivery and glucose monitoring can significantly reduce the burden of hypoglycaemia when used appropriately. However, limitations of the current technology, and the skills, commitment and motivation required to use them, mean that it does not work for all people. Education and informed professional support are key to success. In the context of problematic hypoglycaemia, data suggest that newer technology has lower efficacy and uptake in those with most need. Identifying the causes of hypoglycaemia and understanding some of the underlying behavioural drivers may prove useful and psycho-educational strategies may be effective in selected individuals. Ultimately, as in many spheres of medicine, successful management of problematic hypoglycaemia depends upon matching the right treatment to the right individual.
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Recurrent level 2 hypoglycemia and/or level 3 hypoglycemia is an urgent medical issue and requires intervention with medical treatment plan adjustment, behavioral intervention, and, in some cases, use of technology to assist with hypoglycemia prevention and identification.
“Recurrent level 2 hypoglycemia and/or level 3 hypoglycemia is an urgent medical issue and requires intervention with medical treatment plan adjustment, behavioral intervention, and, in some cases, use of technology to assist with hypoglycemia prevention and identification (76,(79)(80)(81)(82).”
From 6. Glycemic Targets: <i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [81]
Some individuals with type 1 diabetes or type 2 diabetes and hypoglycemia who have a fear of hyperglycemia are resistant to relaxation of glycemic targets.
“Conversely, some individuals with type 1 diabetes or type 2 diabetes and hypoglycemia who have a fear of hyperglycemia are resistant to relaxation of glycemic targets (74)(75)(76)(77)(78)(79)(80)(81)(82)(83).”
From 6. Glycemic Targets: <i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [81]
Among children and adolescents with T1D, alarm fatigue was at least one of the reasons for discontinuing CGM.
“Among 85 children and adolescents between 5 and 18 years old with T1D, alarm fatigue was found to be the main reason for discontinuing CGM [ 43 ], or at least one of the reasons [ 32 , 67 ].”
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6. Glycemic Targets: <i>Standards of Care in Diabetes—2023</i>
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6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2025
American Diabetes Association Professional Practice Committee, ElSayed, N. A., McCoy, R. G., Aleppo, G., Balapattabi, K., Beverly, E. A., Briggs Early, K., Bruemmer, D., Echouffo-Tcheugui, J. B., Ekhlaspour, L., et al. (2025) · Diabetes Care · doi:10.2337/dc25-s006 · Cited by 440 · see citing works
6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026.
American Diabetes Association Professional Practice Committee for Diabetes*, Bajaj, M., McCoy, R. G., Balapattabi, K., Bannuru, R. R., Bellini, N. J., Bennett, A. K., Beverly, E. A., Briggs Early, K., ChallaSivaKanaka, S., et al. (2026) · Diabetes Care · doi:10.2337/dc26-s006 · Cited by 172 · see citing works
Impaired hypoglycaemia awareness in type 1 diabetes: Lessons from the lab
McNeilly, A. D., & McCrimmon, R. J. (2018) · Diabetologia · doi:10.1007/s00125-018-4548-8 · Cited by 55 · see citing works
Giza, S., Kotanidou, E. P., Tsinopoulou, V. R., Poukoulidou, T., Ntouma, S., & Galli-Tsinopoulou, A. (2025) · Children · doi:10.3390/children12121668 · Cited by 7 · see citing works
- Authors
- Choudhary, P., & Amiel, S. A.
- Affiliations
- King's College London (GB)
- Corresponding author
- Amiel, Stephanie A.
- Venue
- Diabetologia
- Published
- 2018-02-08
- Volume
- 61
- Issue
- 4
- Pages
- 761-769
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- PMC
- PMC6448988
- OpenAlex
- W2790913112
- Cited by
- 52
- References
- 88
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 6 · 2023: 7 · 2022: 12 · 2021: 4 · 2020: 5 · 2019: 6 · 2018: 4
- FWCI
- 0.73
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetologia (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (publishedVersion, other-oa)
- Funders
- King's College London
- 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 › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Keywords
- hypoglycemia, type 1 diabetes, continuous glucose monitoring, insulin pump, patient motivation, medication adherence, personalized treatment, diabetes education
- MeSH terms
- Awareness, Blood Glucose, Diabetes Mellitus, Type 1, Mental Fatigue, Fear, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin, Insulin Infusion Systems, Motivation, Patient Compliance, Professional-Patient Relations, Self Care, Blood Glucose Self-Monitoring, Treatment Outcome, Clinical Alarms
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