Effect of automated bio-behavioral feedback on the control of type 1 XXXX .

@entity1 @entity413 @entity6 @entity4053
OBJECTIVE: To test the effect of an automated system providing real-time estimates of HbA(1c), @entity413 variability, and risk for @entity4053 . RESEARCH DESIGN AND METHODS: For 1 year, 120 adults with type 1 @entity6 (69 female/51 male, age = 39.1 [14.3] years, duration of @entity6 20.3 [12.9] years, HbA(1c) = 8.0 [1.5]), performed self-monitoring of blood @entity413 (SMBG) and received feedback at three increasingly complex levels, each continuing for 3 months: level 1--routine SMBG; level 2--adding estimated HbA(1c), @entity4053 risk, and @entity413 variability; and level 3--adding estimates of symptoms potentially related to @entity4053 . The subjects were randomized to feedback sequences of either levels 1-2-3 or levels 2-3-1. HbA(1c), symptomatic @entity4053 , and blood @entity413 awareness were evaluated at baseline and at the end of each level. RESULTS: For all subjects, HbA(1c) was reduced from 8.0 to 7.6 from baseline to the end of study (P = 0.001). This effect was confined to subjects with baseline HbA(1c) >8.0 (from 9.3 to 8.5, P < 0.001). Incidence of symptomatic moderate/severe @entity4053 was reduced from 5.72 to 3.74 episodes/ @entity1 /month (P = 0.019), more prominently for subjects with a history of severe @entity4053 (from 7.20 to 4.00 episodes, P = 0.008) and for those who were @entity4053 unaware (from 6.44 to 3.71 episodes, P = 0.045). The subjects' ratings of the feedback were positive, with up to 89% approval of the provided features. CONCLUSIONS: Feedback of SMBG data and summary SMBG-based measures resulted in improvement in average glycemic control and reduction in moderate/severe @entity4053 . These effects were most prominent in subjects who were at highest risk at the baseline.
