Randomized Controlled Clinical Trial of Blood Glucose Awareness Training (BGAT III) in Switzerland and Germany
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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.
KEY WORDS:blood glucose awareness training severe hypoglycemia psycho-educational program clinical trial hypoglycemia fear
Blood Glucose Awareness Training
1–6 months after intervention
7–12 months after intervention
This study was supported by the Swiss National Diabetes Foundation (SDG), Basel Diabetes Foundation (DGRBB), Walter-und Margarethe von Lichtenstein Foundation, Freie Akademische Gesellschaft Basel, Lilly Inc., Switzerland, and Astra-Fonds. We thank Prof. Dr. Wolf Langewitz and Dr. Brigitta Wössmer, who helped with clinical supervision and advice. We also thank the following diabetes nurses, who were actively engaged in motivating and referring patients: Cornelia Müller, Vreni Bättig, Regula Schinz, Marco Pavan (all Basel) and Bettina Blaser (Luzern).
- Bradley, C. (1994). The well-being questionnaire. In Bradley, C. (Ed.), Handbook of Psychology and Diabetes: A Guide to Psychological Measurement in Diabetes Research and Practice, Harwood Academic Press, Chur, pp. 89–109.Google Scholar
- Cox, D. J., Kovatchev, B. P., Julian, D. M., Gonder-Frederick, L. A., Polonsky, W. H., Schlundt, D. G., and Clarke, W. L. (1994b). Frequency of severe hypoglycemia in insulin-dependent diabetes mellitus can be predicted from self-monitoring blood glucose data. J. Clin. Endocrinol. Metab. 79(6): 1659–1662.CrossRefPubMedGoogle Scholar
- Dahlbert, C. (1992). Subjective well being of young adults. Theoretical and empirical analyses of structure and stability. Zeitschrift für Differentielle und Diagnostische Psychologie 13: 207–220.Google Scholar
- Irvine, A., Cox, D., and Gonder-Frederick, L. (1994). The Fear of Hypoglycaemia Scale. In Bradley, C. (Ed.), Handbook of Psychology and Diabetes. Routledge, London, pp. 133–155.Google Scholar
- Kohlmann, C., Petrak, F., Schuler, M., Krohne, H., Kuestner, E., and Beyer, J. (1995). Diabetes-specific control beliefs: Are changes dependent on critical life events? In Kohlmann, C. and Kulzer, B. (Eds.), Diabetes And Psychology. Diagnostic Approaches. Huber, Bern, pp. 111–118.Google Scholar
- Paschalides, C., Wearden, A. J., Dunkerley, R., Bundy, C., Davies, R., and Dickens, C. M. (2004). The associations of anxiety, depression and personal illness representations with glycaemic control and health-related quality of life in patients with type 2 diabetes mellitus. J. Psychosom. Res. 57(6): 557–564.CrossRefPubMedGoogle Scholar
- Tattersall, R. (1999). Frequency, causes, and treatment of hypoglycemia. In Frier, B., and Fisher, B. (Eds.), Hypoglycemia in Clinical Diabetes, Wiley, Chichester, UK, pp. 55–87. Google Scholar