Interventions That Restore Awareness of @entity4053 in Adults With XXXX : A Systematic Review and Meta-analysis.

@entity1 @entity6 @entity73 @entity4053 @entity1723 @entity413
OBJECTIVE: @entity73 ( @entity73 ) increases the risk of severe @entity4053 (SH) sixfold and affects 30% of adults with @entity1723 ( @entity1723 ). This systematic review and meta-analysis looks at the educational, technological, and pharmacological interventions aimed at restoring @entity4053 awareness (HA) in adults with @entity1723 . RESEARCH DESIGN AND METHODS: We searched The Cochrane Library, MEDLINE, Embase, Science Citation Index Expanded, Social Sciences Citation Index, PsycINFO, and CINAHL from inception until 1 October 2014. Included studies described HA status at baseline. Outcome measures were SH rates, change in HA, counterregulatory hormone responses, and glycemic control. RESULTS: Forty-three studies (18 randomized controlled trials, 25 before-and-after studies) met the inclusion criteria, comprising 27 educational, 11 technological, and 5 pharmacological interventions. Educational interventions included structured @entity6 on flexible insulin therapy, including psychotherapeutic and behavioral techniques. These were able to reduce SH and improve glycemic control, with greater benefit from the latter two techniques in improving @entity73 . Technological interventions (insulin pump therapy, continuous @entity413 monitoring, and sensor-augmented pump) reduced SH, improved glycemic control, and restored awareness when used in combination with structured education and frequent contact. Pharmacological studies included four insulin studies and one noninsulin study, but with low background SH prevalence rates. CONCLUSIONS: This review provides evidence for the effectiveness of a stepped-care approach in the management of @entity1 with @entity73 , initially with structured @entity6 in flexible insulin therapy, which may incorporate psychotherapeutic and behavioral therapies, progressing to @entity6 technology, incorporating sensors and insulin pumps, in those with persisting need.
