medwireNews: A partly web-based hypoglycemia awareness group intervention shows promising results in a randomized controlled trial.
The HypoAware intervention comprises three “highly interactive” group sessions, lasting 2.5 hours each and delivered over 4 weeks by trained diabetes professionals. Interspersed between these sessions are two “user-friendly online modules” and patients’ partners are invited to the third group session.
When tested in insulin-dependent diabetes patients with impaired hypoglycemia awareness, the HypoAware intervention led to improvements in several measures versus usual care, although not all were statistically significant.
Across four timepoints between baseline and 6 months, the 71 patients randomly assigned to the HypoAware group had a 33% reduction in severe hypoglycemia episodes relative to the 66 patients who received usual care, after accounting for demographic and diabetes-related variables, but this was not statistically significant.
However, the median number of severe hypoglycemia episodes over the 6-month period was 1.0 in the HypoAware group versus 2.5 in the control group. This was a significant difference, and, the researchers say, equates to 11 episodes of severe hypoglycemia prevented per one patient attending HypoAware.
The intervention was well received by participants, with 86% attending all three meetings, a further 10% attending two and 90% completing both online modules.
“It is important to note that the observed reductions in severe hypoglycemia were achieved in a sample of patients who were not all seriously affected by severe hypoglycemia (although most had impaired awareness) with access to ongoing comprehensive outpatient diabetes care,” the researchers write in Diabetes Care.
Patients in the HypoAware group achieved a significant 62% reduction in the odds of having impaired hypoglycemia awareness according to Gold score and a 30% reduction in hypoglycemia-related distress measured on the Problem Areas In Diabetes scale.
They also reported an 18% increase in the incidence of nonsevere hypoglycemia events, relative to the control group, but Frank Snoek (VU University Medical Center, Amsterdam, the Netherlands) and study co-authors attribute this finding to improved awareness, rather than increased incidence.
“Importantly, an increase in nonsevere hypoglycemia events in the intervention group did not translate into more worries,” they say.
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