Response to Comment on Little 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). Diabetes Care 2014;37:2114–2122

Hypoglycemia in Type 1 Diabetes Mellitus

“…The patient should be educated about SMBG (including nocturnal testing) and counting carbohydrates to permit a flexible diet. There are many studies in the literature evaluating the effect of patient education on hypoglycemia [39][40][41][42]. In some studies, participation in the diabetes teaching and treatment program (DTTP) improved HbA1C while reducing severe hypoglycemia by approximately 50% [39][40][41].…”

“…Hopkins et al reported improved awareness of hypoglycemia in up to 43% of participants at 1 year follow-up with DTTP [41], and the rate of IAH decreased from 39.9-33%, with improvement in psychological distress and well-being up to 1 year following DTTP [41]. In the HypoCOMPaSS trial, a half-day education about reducing episodes of hypoglycemia was given to all participants [42]. At 6 months, all groups reached great improvement in IAH, and rates of severe hypoglycemia fell from 77-20% at the end of the 6-month trial (8.9 ± 13.4 vs. 0.8 ± 1.8 episodes per person per year; p = 0.0001) [42].…”

“…In the HypoCOMPaSS trial, a half-day education about reducing episodes of hypoglycemia was given to all participants [42]. At 6 months, all groups reached great improvement in IAH, and rates of severe hypoglycemia fell from 77-20% at the end of the 6-month trial (8.9 ± 13.4 vs. 0.8 ± 1.8 episodes per person per year; p = 0.0001) [42]. All these studies show that structured education (defined as insulin self-management and/or specific training for the avoidance of hypoglycemia) is effective in decreasing the rates of severe hypoglycemia in T1DM with improvement in glycemic control.…”