Randomized Controlled Clinical Trial of Blood Glucose Awareness Training (BGAT III) in Switzerland and Germany

Abstract

Although both diabetes and the efficacy of medical management are international issues, psycho-educational interventions might be culturally bound. Blood Glucose Awareness Training (BGAT) is a psycho-educational program for patients with type 1 diabetes mellitus. It is focused on improving recognition and management of extreme blood glucose levels, and is the best documented American psycho-educational program for this purpose. A randomized controlled clinical trial of BGAT's long-term benefits in a non-American setting has been lacking. One hundred and eleven adults with type 1 diabetes mellitus from Switzerland and Germany participated. After a 6 months baseline assessment, subjects were randomly assigned to receive either 2 months of BGAT (n = 56) or a physician-guided self-help control intervention (n = 55). BGAT improved recognition of low (p = 0.008), high (p = .03), and overall blood glucose (p = 0.001), and reduced frequency of severe hypoglycemia (p = 0.04), without compromising metabolic control. BGAT reduced both the external locus of control (p < 0.02) and fear of hypoglycemia (p < 0.02). BGAT was efficacious in reducing adverse clinical events and achieving clinically desirable goals in a European, as well as American setting.

Interventions That Restore Awareness of Hypoglycemia in Adults With Type 1 Diabetes: A Systematic Review and Meta-analysis

“…Glycemic control improved in the U.S.-based BGAT studies (47,48) in both control and intervention groups, but showed no change in the European-BGAT (45). PRIMAS showed improvement in HbA 1c only in the intervention arm (42).…”

“…These studies did not report baseline SH rates (47,48) and people with SH in the preceding 2 years of the study were excluded from the Kinsley et al (47) study. In the European-BGAT study (45), people with recurrent SH were encouraged to participate: SH fell by 88% in the BGAT group compared with the physicianguided self-help control group, which showed no reduction in SH rates. A head-to-head comparison between PRIMAS (42), a new German education program with additional aspects of goalsetting, motivation, and greater hypoglycemia focus, against the well-established DTTP (39) showed equivalent reductions in SH in both intervention and control groups.…”

Flexible Intensive Insulin Therapy in Adults With Type 1 Diabetes and High Risk for Severe Hypoglycemia and Diabetic Ketoacidosis

“…Blood glucose awareness training is an alternative standard self-management program approach that proved to decrease the rate of severe hypoglycemia in type 1 diabetes (15,16). In a 12-month uncontrolled trial, blood glucose awareness training reduced the rate of severe hypoglycemia from 19.2 to 13.2 events ⅐ patient Ϫ1 ⅐ year Ϫ1 (17).…”

Diabetic patients treated with dialysis: complications and quality of life

“…There may be many reasons for these problems with compliance. A known important predictor of good compliance is the patient's own confidence in their ability to control their disease [17][18][19], which in psychology has been described by the term 'locus of control'. Locus of control defines the attitudes of people with regard to the control they have over their life.…”