New education program reduces hypo risk

A new UK program designed to educate adults with type 1 diabetes has been shown to significantly reduce the risk of hypoglycaemic episodes, writes CARLY LUFF.

Researchers at King’s College Hospital in London have trialled a new educational program, aimed at reducing hypoglycaemic episodes which occur when blood glucose falls to a potentially dangerous low. Hypoglycaemic episodes — colloquially known as “hypos” — can be very serious if untreated, impairing normal brain function, causing confusion and sometimes proving fatal. People with type 1 diabetes will be familiar with the dangers of hypos and will be aware how essential it is to treat one with fast-acting carbohydrates to restore blood glucose levels. Nonetheless, they can be distressing for patients and their loved ones.

The six-week pilot program, known as HARPdoc or Hypoglycaemia Awareness Restoration Program for adults with type 1 diabetes, was trialled with patients across three sites in the UK and one in the US between 2017 and 2021. It was funded by the Juvenile Diabetes Research Foundation International, with additional support from the UK’s National Institute of Health Research.

The program, which aims to change how people think about their hypoglycaemia, is delivered by trained diabetes educators to small groups, online or face-to-face, over six weeks, followed by reinforcement at three and six months. It uses psychological theory to address unhelpful health beliefs that act as barriers to hypoglycaemia avoidance. HARPdoc educators have been trained to use psychological therapy techniques to help participants during the program. These educators are supported by the HARPdoc psychology team, while people participating in HARPdoc remain under the care of their usual diabetes care provider. The patients recruited into the trial had lived with type 1 diabetes for many years. Half of the participants reported having problems with hypoglycaemia for more than 10 years, despite having access to therapies and technologies for effective insulin delivery and blood glucose monitoring. The program was particularly targeted at patients with type 1 diabetes who were experiencing repeated severe hypos, after having lost their ability to identify the early symptoms. Participants were asked to describe their thoughts about hypoglycaemia, to help them regain awareness and avoid future attacks.

Half of the trial participants received the HARPdoc intervention and the remaining half were treated with a different NHS-approved program, known as Blood Glucose Awareness Testing or BGAT, which does not address the thoughts and health beliefs about hypoglycaemia. The participants were all followed for 24 months.

Both programs were found to reduce hypos when offered to patients who had already completed structured education programmes. However, HARPdoc was also shown to improve mental health and reduce patients’ level of distress related to their diabetes.

Participants reported lower levels of anxiety and depression on having completed the trial. This improvement in mental health, alongside experiencing fewer episodes of severe hypoglycaemia, is seen as a great success by the researchers. Programs such as HARPdoc, which involve an element of education and reasoning, could be a cost-effective intervention, relieving physical and mental distress for adults living with type 1 diabetes. They may prove a valuable tool for people experiencing severe hypoglycaemia to use alongside their existing treatments. The intervention could also reduce a patient’s need for additional health service support over time. The success of the trial in both the UK and the US suggests it could be effectively implemented in Australia, alongside existing programs.