Patients with type-1 diabetes who are unaware that they are hypoglycemic may have a five-fold increased risk of severely reduced glucose concentrations. Yet hypoglycemia awareness can be restored if patients can switch to and stick with a different insulin regimen. In general, however, these patients are less adherent to agreed-on changes in insulin therapy, even with more clinic visits, compared with patients who are hypoglycemia-aware.
In a study of 90 patients, investigators from King’s College London School of Medicine identified 31 patients as aware of their hypoglycemia and 19 patients as hypoglycemia-unaware. Only 50% of the hypoglycemia-unaware patients were adherent to therapy, compared with 87% of hypoglycemia-aware patients.
Failure to perceive a situation as unpleasant or dangerous undermines motivation and the ability to change behavior. In this study, about half of the patients with hypoglycemia unawareness had been in a structured education program that both reduced severe hypoglycemia rates and restored hypoglycemia awareness. The researchers concluded that it might be a good idea to include behavioral strategies that address habitual behavior.
Source: Diabetes Care 2009;32:1196-1198