A MULTICENTER EVALUATION OF BLOOD-GLUCOSE AWARENESS TRAINING .2.

OBJECTIVE-Blood glucose awareness training (BGAT) teaches individuals with insulin-dependent diabetes to more accurately estimate/detect the ir blood glucose (BG) fluctuations. It has not, however, consistently resulted in improved ability to detect low BG. To assess an enhanced v ersion of BGAT (BGAT-II), with more focus on increasing sensitivity to low BG events, a multicenter study was undertaken. Following up on pr evious findings that BGAT is most effective with individuals who are l east accurate in estimating BG, this study explicitly recruited subjec ts who did and did not report reduced awareness of hypoglycemia.RESEAR CH DESIGN AND METHODS-Seventy-eight subjects from three research sites participated in a repeated baseline design. Subjects' BG estimation a ccuracy and BG profiles were assessed 6 months before, immediately bef ore, and immediately after BGAT-II. RESULTS-Post-treatment, BGAT-II le d to better overall accuracy in detecting BG fluctuations and better d etection of both low and high BG levels. This was achieved while the n umber of low readings of self-monitoring of blood glucose (SMBG) was r educed. Reduction in the number of low SMBG events was significant onl y for subjects reporting awareness of hypoglycemia. Detection of low B G was significant only for subjects reporting reduced awareness of hyp oglycemia. Both groups demonstrated equivalent improvements in detecti on of high BG levels. CONCLUSIONS-BGAT may be an effective behavioral strategy for reversing hypoglycemic unawareness and an adjunct to inte nsive insulin therapy to reduce the occurrence of severe hypoglycemia.