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Hypoglycemic unawareness monitoring tools

Hypoglycemic unawareness monitoring tools

Neuroimaging Nutrition periodization for performance have Allergy relief during allergy season that Hypoglycemic unawareness monitoring tools with HU monitorign a reduced activation in appetitive motivational networks associated with integrated behavioral nuawareness to hypoglycemia[ 34 Hypoglycemic unawareness monitoring tools. Unawareneas I, Suissa Monitlring, Allergy relief during allergy season J, Schiffrin A. The continuous glucose monitoring system CGMS is rapidly improving diabetes management and has been proved to be superior to daily self-monitoring blood glucose SMBG in the detection of hypoglycemia and in improving glycemic control in T2DM individuals [ 12 ]. Reduced sympathoadrenal responses during hypoglycemia may contribute to defective glucose counter-regulation and HU[ 8384 ]. Hypoglycemic unawareness monitoring tools

Hypoglycemic unawareness monitoring tools -

Missing data were handled by direct likelihood, which maximizes the likelihood function integrated over possible values of the missing data. Binary HbA 1c outcomes were compared between treatment groups using available cases only in a logistic regression model adjusting for baseline HbA 1c and clinical center as a random effect.

Modification of the treatment effect by baseline variables was assessed by including an interaction term in the primary model. Sensitivity analyses were performed as described in the statistical analysis plan adjustment for potential confounding of baseline imbalances and including only participants meeting per-protocol criteria Supplement 1.

Analysis of all outcomes was repeated separately among insulin pump and injection users and paralleled the overall analysis described above. Additional analyses also were performed for data collected through 16 weeks and data collected separately during daytime am to pm and nighttime am to am hours for CGM outcomes.

Analyses were conducted with SAS software version 9. Sixteen patients who provided consent and were screened for the study did not proceed into the randomized clinical trial Figure 1. Participant characteristics overall and according to randomization group are shown in Table 1 and additionally stratified by insulin delivery method in eTable 4 in Supplement 2.

Participant comorbidities and medications are reported in eTables 5 and 6 and in Supplement 2 , respectively. Unscheduled visits and contacts are reported in eTable 7 in Supplement 2.

In the CGM group, CGM use was high throughout the study eTable 8 in Supplement 2. Use of CGM was similar between those who used a pump and those who used injections for insulin delivery eTable 9 in Supplement 2. Two participants in the standard BGM group initiated real-time CGM use during the trial.

Results were similar for other CGM hypoglycemia metrics Table 2 and eTable The significant treatment effect was evident in the first month and remained consistent over 6 months Figure 2 A and eTable 11 in Supplement 2.

Results were similar in a sensitivity analyses that adjusted for characteristics with some imbalance at baseline duration of diabetes, sex, education, severe hypoglycemia in the 12 months prior to the study, and functional activity [questionnaire score] and in a per-protocol sensitivity analysis eTable 12 in Supplement 2.

Mean HbA 1c was 7. Additional HbA 1c metrics are shown in eTable 17 in Supplement 2. One participant in the CGM group and 10 participants in the standard BGM group experienced a severe hypoglycemia event during the 6 months of follow-up Table 3. One episode of diabetic ketoacidosis occurred during the study in a participant in the CGM group, unrelated to use of CGM Table 3.

There were no statistically significant treatment group differences in fractures, falls, hospitalizations, or emergency department visits. There were 22 CGM device issues reported over the week follow-up eTable 18 in Supplement 2 , none of which were related to an adverse event. No significant treatment group differences were observed at 26 weeks for any of the participant-reported questionnaires or cognitive assessments, including measures of hypoglycemia awareness, diabetes-specific quality of life hypoglycemia fear, diabetes distress, and glucose monitoring satisfaction , general quality of life, and cognition eTable 19 in Supplement 2.

A similar degree of hypoglycemia reduction was seen in those using insulin pump therapy and those using multidose insulin injection therapy. Results were consistent across the age range of 60 to 86 years, across the baseline HbA 1c range of 5. The higher the amount of baseline hypoglycemia and glycemic variability, risk factors for severe hypoglycemia in older adults with type 1 diabetes, 22 the greater the treatment effect.

Despite improvements in various measures of hypoglycemia and glycemic control and the high degree of CGM use after 6 months, there were no significant treatment group differences in patient-reported outcomes, including fear of hypoglycemia and diabetes distress.

One possible explanation is that the baseline scores on these measures were quite low, indicating already good adjustment to managing diabetes. The findings in this trial are consistent with a subgroup analysis of the participants in the DIAMOND study, who were aged 60 years or older, with respect to the high degree of CGM use after 6 months and the benefit of CGM on reducing hyperglycemia and HbA 1c ; however, the DIAMOND cohort had too little baseline hypoglycemia for a meaningful assessment of the effect of CGM on hypoglycemia.

The strengths of this study include random treatment assignment, high participant retention rate, high degree of CGM use by the CGM group, and only 2 treatment crossovers by the standard BGM group.

Although treatment group assignment could not be masked, the amount of contact with participants was similar between groups. This study has several limitations. First, the study cohort had relatively high socioeconomic status and consisted of individuals receiving specialized diabetes care.

On average, baseline glycemic control was good and the amount of biochemical hypoglycemia was modest. Median age at diagnosis was 30 years, but the treatment effect appeared similar irrespective of age at diagnosis. Second, there was a relatively short intervention period of 6 months. This study included an extension phase during which the CGM group continued using CGM through 12 months and the standard BGM group initiated CGM.

Results of the extension phase may provide insight into longer-term use of CGM. Third, the study intervention used an older version of the CGM sensor than what is now commercially available. It is unknown whether the additional features of the newer CGM sensor such as no calibration requirement, easier insertion process, and a predictive low glucose alert would have further increased CGM use in this population.

Fourth, the study intervention also did not include a system that suspends insulin delivery from a pump when hypoglycemia is predicted based on the CGM glucose readings. Such a system for pump users might have an even greater effect on reducing hypoglycemia than was seen in this study.

Among adults aged 60 years or older with type 1 diabetes, CGM compared with standard BGM resulted in a small but statistically significant improvement in hypoglycemia over 6 months.

Corresponding Author: Richard E. Pratley, MD, AdventHealth Translational Research Institute, E Princeton St, Orlando, FL richard. md adventhealth. Author Contributions: Dr Miller had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Pratley, Rickels, Ahmann, Aleppo, Beck, Carlson, Chaytor, Fox, Goland, Hirsch, Kruger, Kudva, Peters, Pop-Busui, Shah, Verdejo, Miller.

Acquisition, analysis, or interpretation of data: Pratley, Kanapka, Rickels, Ahmann, Aleppo, Bhargava, Bode, Carlson, Chaytor, Fox, Goland, Hirsch, Kruger, Kudva, Levy, McGill, Peters, Philipson, Philis-Tsimikas, Pop-Busui, Shah, Thompson, Vendrame, Weinstock, Miller.

Drafting of the manuscript: Pratley, Kanapka, Rickels, Carlson, Kudva, Peters, Philis-Tsimikas, Thompson, Miller.

Critical revision of the manuscript for important intellectual content: Pratley, Kanapka, Rickels, Ahmann, Aleppo, Beck, Bhargava, Bode, Carlson, Chaytor, Fox, Goland, Hirsch, Kruger, Kudva, Levy, McGill, Peters, Philipson, Philis-Tsimikas, Pop-Busui, Shah, Vendrame, Verdejo, Weinstock.

Administrative, technical, or material support: Rickels, Beck, Bode, Carlson, Chaytor, Goland, Philipson, Vendrame, Verdejo, Miller. Supervision: Pratley, Rickels, Ahmann, Aleppo, Beck, Carlson, Chaytor, Goland, Hirsch, Kudva, Levy, Peters, Philipson, Vendrame, Weinstock, Miller.

Dr Ahmann reported contract research payments to his institution from Dexcom and receipt of personal fees from Medtronic. Dr Aleppo reported receipt of grants from Novo Nordisk, Dexcom, AstraZeneca, and Lilly and personal fees from Dexcom, Medtronic, Insulet, and Novo Nordisk.

Dr Beck reported consulting fees paint to his institution from Bigfoot Biomedical, Tandem Diabetes Care, Insulet, and Lilly and receipt of grants from Dexcom and Tandem Diabetes Care and nonfinancial support from Dexcom, Tandem Diabetes Care, Roche, and Ascensia.

Dr Chaytor reported receipt of personal fees from Lilly. Dr Kruger reported receipt of grants and personal fees from Dexcom. Dr Levy reported receipt of nonfinancial support from Dexcom.

Dr McGill reported receipt of personal fees from Aegerion, Bayer, Boehringer Ingelheim, Gilead, Lilly, Metavant, Valeritas, Janssen, Mannkind, the Endocrine Society, the American Association of Clinical Endocrinologists, Culinary Medicine, Novo Nordisk, and Dexcom; grants from Novo Nordisk, Dexcom, Medtronic, Novartis, AstraZeneca, and the NIH; and nonfinancial support from Bayer, Boehringer Ingelheim, the American Association of Clinical Endocrinologists, Mannkind, Culinary Medicine, and the Jaeb Center for Health Research.

Dr Peters reported receipt of personal fees from Medscape, Sanofi, Lexicon, Becton Dickinson, Abbot Diabetes Care, Bigfoot, Mannkind, Novo Nordisk, Lilly, and Boehringer Ingelheim; grants from AstraZeneca, vTv Therapeutics, Mannkind, and Dexcom; and stock options for Mellitus Health, Omada Health, Stability Health, Pendulum Therapeutics, and Livongo.

Dr Shah reported receipt of consulting fees through the University of Colorado from Dexcom and grants from vTv therapeutics, Novo Nordisk, Mylan GmbH, Sanofi US Services Inc, Insulet, and the NIH. Dr Weinstock reported receipt of grants from the Juvenile Diabetes Research Foundation, Insulet Corporation, Tolerion Inc, Lilly, Medtronic, Diasome Pharmaceuticals, Boehringer Ingelheim, Oramed Ltd, and Mylan GmbH and personal fees from Insulogic.

Dr Miller reported receipt of nonfinancial support from Dexcom and Tandem. No other disclosures were reported. and Harry B. Helmsley Charitable Trust by a grant provided to the Jaeb Center for Health Research.

The National Center for Research Resources and the National Center for Advancing Translational Sciences of the NIH grant UL1TR support the Center for Human Phenomic Science at the University of Pennsylvania. Dexcom provided study CGM devices and sensors.

Helmsley Charitable Trust, and Dexcom were not involved in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; or in writing the original manuscript draft or revision of the manuscript. JDRF, the Leona M.

Helmsley Charitable Trust, and Dexcom were sent the manuscript for review, but any revisions made based on their comments were at the discretion of the authors, and permission for submitting content to the journal was not required.

There was no approval of JDRF, the Leona M. Helmsley Charitable Trust, or Dexcom required or obtained for manuscript submission. WISDM Study Group: Participating principal investigators PIs , coinvestigators Is , primary coordinator PCs , and coordinators Cs are listed below.

All study personnel listed below were involved in data collection. Additional roles beyond data collection are noted. Miller, PhD; Alandra Verdejo, MPH; Nicole Reese, BS; David McNabb, AS; Heidi Strayer, PhD; Kamille Janess, BS; Israel Mahr, MS; Lauren Kanapka, MSc; Craig Kollman, PhD; Roy Beck, MD, PhD; WISDM Operations committee members: Richard Pratley, MD; Michael Rickels, MD, MPH; Naomi Chaytor, PhD; D.

Steven Fox, MD; Kellee M. Miller, PhD; Data and Safety Monitoring Board: Mark Espeland, PhD, FASA chair ; Guillermo Umpierrez, MD, CDE; Mary Korytkowski, MD; Matthew Gilbert, DO. Meeting Presentation: The trial results were presented at the American Diabetes Association meeting in San Francisco, California, on June 9, , and at the European Association for the Study of Diabetes meeting in Barcelona, Spain, on September 17, Data Sharing Statement : See Supplement 3.

full text icon Full Text. Download PDF Top of Article Key Points Abstract Introduction Methods Results Discussion Conclusions Article Information References. Visual Abstract.

Continuous Glucose Monitoring and Hypoglycemia in Older Adults With Type 1 Diabetes. View Large Download. Figure 1. Flow of Participants in the Wireless Innovation for Seniors With Diabetes Mellitus WISDM Study.

a Information on patients screened but not enrolled was not collected. Figure 2. Table 1. Baseline Characteristics of Study Participants. Table 3. Safety Outcomes: Severe Hypoglycemia and Other Adverse Events. Supplement 1. Trial Protocol and Statistical Analysis Plan. Supplement 2.

eTable 1. Eligibility and Exclusion Criteria eTable 2. Description of Cognitive Assessment and Patient-Reported Outcomes eTable 3. Multiple Comparisons Summary eTable 4.

Baseline Characteristics by Pump and MDI Users eTable 5. Comorbidities at Enrollment eTable 6. Types of Medications at Enrollment eTable 7. Unscheduled Contacts eTable 8.

Real-time CGM Use eTable 9. Real-time CGM Use by Pump and MDI Users eTable CGM Metrics in Time per Day eTable Glycemic Outcomes at 16 Weeks eTable CGM Metrics During the Daytime AMPM and Nighttime AMAM eTable Glycemic Outcomes Among Participants Using a Pump for Insulin Delivery eTable Glycemic Outcomes Among Participants Using Injections for Insulin Delivery eTable Binary HbA1c Outcomes eTable Device Issues eTable Cognitive Assessment and Patient-Reported Outcomes eFigure 1.

Visit Completion by Treatment Group eFigure 2. CGM Education Materials eReferences. Supplement 3. Data Sharing Statement. Secrest AM, Becker DJ, Kelsey SF, LaPorte RE, Orchard TJ. All-cause mortality trends in a large population-based cohort with long-standing childhood-onset type 1 diabetes: the Allegheny County type 1 diabetes registry.

doi: Lipska KJ, Ross JS, Wang Y, et al. National trends in US hospital admissions for hyperglycemia and hypoglycemia among Medicare beneficiaries, to Stahn A, Pistrosch F, Ganz X, et al. Relationship between hypoglycemic episodes and ventricular arrhythmias in patients with type 2 diabetes and cardiovascular diseases: silent hypoglycemias and silent arrhythmias.

Battelino T, Danne T, Bergenstal RM, et al. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the International Consensus on Time in Range.

Weinstock RS, Xing D, Maahs DM, et al; T1D Exchange Clinic Network. Severe hypoglycemia and diabetic ketoacidosis in adults with type 1 diabetes: results from the T1D Exchange Clinic Registry. Aleppo G, Ruedy KJ, Riddlesworth TD, et al; REPLACE-BG Study Group. REPLACE-BG: a randomized trial comparing continuous glucose monitoring with and without routine blood glucose monitoring in adults with well-controlled type 1 diabetes.

Tamborlane WV, Beck RW, Bode BW, et al; Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. Continuous glucose monitoring and intensive treatment of type 1 diabetes.

Battelino T, Phillip M, Bratina N, Nimri R, Oskarsson P, Bolinder J. Effect of continuous glucose monitoring on hypoglycemia in type 1 diabetes. Ruedy KJ, Parkin CG, Riddlesworth TD, Graham C; DIAMOND Study Group. Continuous glucose monitoring in older adults with type 1 and type 2 diabetes using multiple daily injections of insulin: results from the DIAMOND trial.

Lind M, Polonsky W, Hirsch IB, et al. Continuous glucose monitoring vs conventional therapy for glycemic control in adults with type 1 diabetes treated with multiple daily insulin injections: the GOLD randomized clinical trial.

Davis SN, Horton ES, Battelino T, Rubin RR, Schulman KA, Tamborlane WV. STAR 3 randomized controlled trial to compare sensor-augmented insulin pump therapy with multiple daily injections in the treatment of type 1 diabetes: research design, methods, and baseline characteristics of enrolled subjects.

Little SA, Leelarathna L, Walkinshaw E, et al. Recovery of hypoglycemia awareness in long-standing type 1 diabetes: a multicenter 2×2 factorial randomized controlled trial comparing insulin pump with multiple daily injections and continuous with conventional glucose self-monitoring HypoCOMPaSS.

Patton SR. Adherence to glycemic monitoring in diabetes. Beck RW, Riddlesworth T, Ruedy K, et al; DIAMOND Study Group. Effect of continuous glucose monitoring on glycemic control in adults with type 1 diabetes using insulin injections: the DIAMOND randomized clinical trial.

Aleppo G, Laffel LM, Ahmann AJ, et al. A practical approach to using trend arrows on the Dexcom G5 CGM system for the management of adults with diabetes. It is safer and more effective to prevent hypoglycemia than to treat it after it occurs, so people with diabetes who are at high risk for hypoglycemia should be identified and counselled about ways to prevent low blood glucose.

It is important to counsel individuals who are at risk of hypoglycemia and their support persons about the recognition and treatment of hypoglycemia. The goals of treatment for hypoglycemia are to detect and treat a low blood glucose level promptly by using an intervention that provides the fastest rise in blood glucose to a safe level, to eliminate the risk of injury and to relieve symptoms quickly.

Once the hypoglycemia has been reversed, the person should have the usual meal or snack that is due at that time of the day to prevent repeated hypoglycemia.

It is important to avoid overtreatment of hypoglycemia, since this can result in rebound hyperglycemia and weight gain.

Key Messages for People with Diabetes Know the signs and symptoms of a low blood glucose level. Some of the more common symptoms of low blood glucose are trembling, sweating, anxiety, confusion, difficulty concentrating or nausea.

Not all symptoms will be present and some individuals may have other or no symptoms. Wear diabetes identification e. a MedicAlert® bracelet Talk with your diabetes health-care team about prevention and emergency treatment of a severe low blood glucose associated with confusion, loss of consciousness or seizure.

Introduction Drug-induced hypoglycemia is a major obstacle for individuals trying to achieve glycemic targets. Complications of Severe Hypoglycemia Short-term risks of hypoglycemia include the dangerous situations that can arise while an individual is hypoglycemic, whether at home or at work e.

Treatment of Hypoglycemia The goals of treatment for hypoglycemia are to detect and treat a low BG level promptly by using an intervention that provides the fastest rise in BG to a safe level, to eliminate the risk of injury and to relieve symptoms quickly.

Recommendations All people with diabetes currently using or starting therapy with insulin or insulin secretagogues and their support persons should be counselled about the risk, prevention, recognition and treatment of hypoglycemia.

Risk factors for severe hypoglycemia should be identified and addressed [Grade D, Consensus]. The DHC team should review the person with diabetes' experience with hypoglycemia at each visit, including an estimate of cause, frequency, symptoms, recognition, severity and treatment, as well as the risk of driving with hypoglycemia [Grade D, Consensus].

In people with diabetes at increased risk of hypoglycemia, the following strategies may be used to reduce the risk of hypoglycemia: Avoidance of pharmacotherapies associated with increased risk of recurrent or severe hypoglycemia see Glycemic Management in Adults with Type 1 Diabetes, p.

S88, for further discussion of drug-induced hypoglycemia [Grade D, Consensus] A standardized education program targeting rigorous avoidance of hypoglycemia while maintaining overall glycemic control [Grade B, Level 2 83 ] Increased frequency of SMBG, including periodic assessment during sleeping hours [Grade D, Consensus] Less stringent glycemic targets with avoidance of hypoglycemia for up to 3 months [Grade D, Level 4 37,38 ] A psycho-behavioural intervention program blood glucose awareness training [Grade C, Level 3 40 ] Structured diabetes education and frequent follow up [Grade C, Level 3 42 for type 1 diabetes; Grade D, Consensus for type 2].

In people with diabetes with recurrent or severe hypoglycemia, or impaired awareness of hypoglycemia, the following strategies may be considered to reduce or eliminate the risk of severe hypoglycemia and to attempt to regain hypoglycemia awareness: Less stringent glycemic targets with avoidance of hypoglycemia for up to 3 months [Grade D, Level 4 37,38 ] CSII or CGM or sensor augmented pump with education and follow up for type 1 diabetes [Grade B, Level 2 42,44,46,47 ] Islet transplantation for type 1 diabetes [Grade C, Level 3 48 ] Pancreas transplantation for type 1 diabetes [Grade D, Level 4 50—53 ].

These are preferable to orange juice and glucose gels [Grade B, Level 2 73 ]. Note : This does not apply to children. See Type 1 Diabetes in Children and Adolescents, p. S; and Type 2 Diabetes in Children and Adolescents, p. S, for treatment options in children.

For people with diabetes at risk of severe hypoglycemia, support persons should be taught how to administer glucagon [Grade D, Consensus]. Abbreviations: A1C , glycated hemoglobin; BG, blood glucose; CVD , cardiovascular disease; CGM , continuous glucose monitoring; CSII , continuous subcutaneous insulin infusion; DHC , diabetes health-care team; SMBG , self-monitoring of blood glucose.

Other Relevant Guidelines Chpater 8. Targets for Glycemic Control Chapter 9. Monitoring Glycemic Control Chapter Glycemic Management in Adults With Type 1 Diabetes Chapter Pharmacologic Glycemic Management of Type 2 Diabetes in Adults Chapter Diabetes and Driving Chapter Type 1 Diabetes in Children and Adolescents Chapter Type 2 Diabetes in Children and Adolescents Chapter Diabetes and Pregnancy Chapter Diabetes in Older People.

Author Disclosures Dr. References Alvarez-Guisasola F, Yin DD, Nocea G, et al. Health Qual Life Outcomes ; Anderbro T, Amsberg S, Adamson U, et al.

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Type 1 diabetes among adolescents: Reduced diabetes self-care caused by social fear and fear of hypoglycemia. Diabetes Educ ;— Haugstvedt A,Wentzel-Larsen T, GraueM, et al. Fear of hypoglycaemia in mothers and fathers of children with type 1 diabetes is associated with poor glycaemic control and parental emotional distress: A population-based study.

Hepburn DA. Symptoms of hypoglycaemia. In: Frier BM, Fisher BM, eds. Hypoglycaemia and diabetes: clinical and physiological aspects. London: Edward Arnold, , pg. The Diabetes Control and Complications Trial Research Group. Adverse events and their association with treatment regimens in the diabetes control and complications trial.

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Epidemiology of severe hypoglycemia in the diabetes control and complications trial. Am J Med ;—9. Davis EA, Keating B, Byrne GC, et al. Hypoglycemia: Incidence and clinical predictors in a large population-based sample of children and adolescents with IDDM.

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Mokan M, Mitrakou A, Veneman T, et al. Hypoglycemia unawareness in IDDM. Meyer C, Grossmann R, Mitrakou A, et al. Effects of autonomic neuropathy on counterregulation and awareness of hypoglycemia in type 1 diabetic patients.

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Nocturnal hypoglycemia in children and adolescents with insulin-dependent diabetes mellitus: Prevalence and risk factors. Vervoort G, Goldschmidt HM, van Doorn LG. Diabet Med ;—9. Ovalle F, Fanelli CG, Paramore DS, et al.

Brief twice-weekly episodes of hypoglycemia reduce detection of clinical hypoglycemia in type 1 diabetes mellitus. Diabetes ;—9. Fanelli CG, Epifano L, Rambotti AM, et al. Meticulous prevention of hypoglycemia normalizes the glycemic thresholds and magnitude of most of neuroendocrine responses to, symptoms of, and cognitive function during hypoglycemia in intensively treated patients with short-term IDDM.

Dagogo-Jack S, Rattarasarn C, Cryer PE. Reversal of hypoglycemia unawareness, but not defective glucose counterregulation, in IDDM. Fanelli C, Pampanelli S, Epifano L, et al. Long-term recovery from unawareness, deficient counterregulation and lack of cognitive dysfunction during hypoglycaemia, following institution of rational, intensive insulin therapy in IDDM.

Dagogo-Jack S, Fanelli CG, Cryer PE. Durable reversal of hypoglycemia unawareness in type 1 diabetes. Diabetes Care ;—7. Davis M, Mellman M, Friedman S, et al. Recovery of epinephrine response but not hypoglycemic symptomthreshold after intensive therapy in type 1 diabetes. Am J Med ;— Liu D, McManus RM, Ryan EA.

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J Behav Med ;— Yeoh E, Choudhary P, Nwokolo M, et al. Interventions that restore awareness of hypoglycemia in adults with type 1 diabetes: A systematic review and metaanalysis. van Dellen D, Worthington J, Mitu-Pretorian OM, et al. Mortality in diabetes: Pancreas transplantation is associated with significant survival benefit.

Nephrol Dial Transplant ;— Ly TT, Nicholas JA, Retterath A, et al. Effect of sensor-augmented insulin pump therapy and automated insulin suspension vs standard insulin pump therapy on hypoglycemia in patients with type 1 diabetes: A randomized clinical trial.

JAMA ;—7. Little SA, Leelarathna L,Walkinshaw E, et al. Recovery of hypoglycemia awareness in long-standing type 1 diabetes: A multicenter 2 x 2 factorial randomized controlled trial comparing insulin pump with multiple daily injections and continuous with conventional glucose self-monitoring HypoCOMPaSS.

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Each person's reaction to hypoglycemia is Monitorinv. As unpleasant as they may be, these symptoms are useful as they help let you know Hypoglycemic unawareness monitoring tools action is needed to monitoriing a low blood sugar. This is called Role of inflammation in heart disease unawareness. People unawxreness hypoglycemia Hypoglycmic Hypoglycemic unawareness monitoring tools not able to tell when their blood sugar goes too low and may need help from someone else to treat it — this is also known as a severe low. If you or someone you know has hypoglycemia unawareness, it is important to check blood sugar frequently or wear a continuous glucose monitor CGM. This is important for critical tasks such as driving. The only CGM that can alert up to an hour before a high or low so that people with diabetes can get ahead of their lows. Enrollment took fools from Toole to May Hypoglycemic unawareness monitoring tools, and study Hypoglyemic for Natural body cleanse Allergy relief during allergy season trial mnitoring through December BGM indicates blood glucose monitoring; CGM, continuous glucose monitoring. c Two participants in the standard BGM group initiated real-time CGM before completing the week visit. d One participant in the CGM group and 6 participants in the standard BGM group were missing CGM data at follow-up. Missing data were handled using direct likelihood.

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