Original Article

Effect of Education on Impaired Hypoglycemia Awareness and Glycemic Variablity in Children and Adolescents with Type 1 Diabetes Mellitus


  • Günay Demir
  • Samim Özen
  • Hafize Çetin
  • Şükran Darcan
  • Damla Gökşen

J Clin Res Pediatr Endocrinol 0;0(0):0-0 [e-Pub] PMID: 30701953


The aim of this study was to determine the prevalence of impaired hypoglycemia awareness (IHA) in children and adolescents with type 1 diabetes mellitus with professional continuous glucose monitoring system and to show the effect of structured education on glycemic variability (GV) in children and adolescents with IHA.


Fourty type 1 diabetic children and adolescents with a diabetes duration of at least 5 years were eligible for inclusion in this prospective, quantitative study. All subjects were asked about their history of being aware of the symptoms of hypoglycemia with a questionnaire. Professional continuous glucose monitoring (CGM) were placed to all of the patients for six days. The frequency of IHA detected by CGM and logbook reports were analyzed. Patients with IHA diagnosed by CGM underwent a structured training program. After 3 months, CGM was re-applied to patients with IHA.


The study was completed by 37 diabetic children and adolescents. After the initial CGM nine patients (24.3%) were determined to have had episodes of IHA. Area under the curve (AUC) for hypoglycemia and number of low excursions were; 1.81±0.95 and 8.33±3.60 for the IHA group at the beginning of the study. AUC for hypoglycemia was 0.43±0.47 after three months of structured education the IHA patients (p=0.01). Coefficient of variation (CV) which shows primary glycemic variability decreased significantly although unstable at the end of education in IHA patients (p=0.03).


CGM is a valuable tool to diagnose impaired hypoglycemia awareness. IHA, GV and time in range can be improved by education-based intervention.

Keywords: Continuous glucose monitoring, education, impaired hypoglycemia awareness, glycemic variability, type 1 diabetes, children