The effect of an education programme (HyPOS) to treat hypoglycaemia problems in patients with type 1 diabetes

Background: In a randomized, prospective multi-centre trial, the effect of a specific training programme (HyPOS) for patients with hypoglycaemia problems was compared with a control group (CG), receiving a standardized education programme aiming at avoidance of hypoglycaemia by optimization of insulin therapy. Methods: A total of 164 type 1 diabetes patients (age 46.0 ± 12.5 yrs, HbA1c 7.3 ± 1.0%, 50% male) were randomized. Hypoglycaemia awareness was measured by the hypoglycaemia awareness questionnaire (HAQ) and by a visual analogue scale (VAS). There were no baseline differences. Results: After a 6-month follow-up, hypoglycaemia awareness significantly improved in HyPOS compared to that in the CG ( HAQ 0.7 [95% CL 0.1–1.2], p = 0.024, VAS 0.8 [95% CL 0.2–1.2], p = 0.015). In HyPOS, the threshold for detection of low blood glucose ( 0.2 mmol/L [95% CL 0.03–0.04], p = 0.02) and the treatment of low blood glucose ( 4.6 g [95% CL 1.6 – 7.6], p = 0.03) increased significantly. The number of undetected hypogylcaemic episodes ( − 1.4 episodes per week [95% CL 0.4–2.5], p = 0.01) and the rate of mild hypoglycaemia dropped significantly in HyPOS ( 2.1% [95% CL 0.5–5.3], p = 0.015). The numbers of severe ( 0.3 events per patient per year [95% CL −0.04–1.0], p = 0.037) and very severe hypoglycaemic episodes ( 0.3 events per patient per year [95% CL −0.1–0.7], p = 0.09) were lower in HyPOS, but these differences were not significant. Conclusion: Compared to the CG, HyPOS demonstrates additional benefits in terms of improving impaired hypoglycaemia awareness, reducing mild hypoglycaemia, detecting low blood glucose, and treating low blood glucose