Over the past 20 years, a group of researchers at the University of Virginia Health Science System have developed and tested a training program, called Blood Glucose Awareness Training (BGAT), for adults with type 1 diabetes. This research was funded both by the National Institutes of Health and the American Diabetes Association.
BGAT was designed to help people improve their ability to recognize, anticipate and prevent extreme fluctuations in blood glucose (BG) levels. The training program is based on the self-regulation theory of diabetes treatment, which emphasizes the need to provide people with the accurate information and “feedback” they need to do the complex task of managing their diabetes.
Thousands of people from different parts of the world have used BGAT. But, as the evidence for the benefits of BGAT grew, so did the demand for the program. Making BGAT available to everyone who wanted access to the program proved to be a significant challenge.
Bringing BGAT to the Internet
In an effort to solve this dilemma and make BGAT more widely available, the University of Virginia research team has developed an Internet version of the training program, called BGATHome. With BGATHome, people with diabetes will be able to complete this training in their homes and can receive frequent and in-depth feedback about how they are progressing.
The structure and format of BGATHome is similar to the original BGAT, with seven “units” that are ideally completed over seven weekly sessions. The weekly units focus on the causes of BG symptoms; how to identify the best personal signs of low or high BG; the effects of BG changes on mood and behavior; how to increase early warning signs for hypoglycemia; reducing the risk for severe hypoglycemia; insulin action curves and risk for extreme BG levels; and predicting the effects of food and physical activity on BG levels.
Each unit is based on “active learning” and includes exercises to be done during the week to increase awareness of personal BG “cues” and patterns, as well as daily diaries that provide feedback regarding accuracy of BG detection.
More than a dozen studies have tested the usefulness of BGAT in the United States the Netherlands, Germany, Switzerland and Japan. The results of these studies have shown that people who participate in BGAT may benefit in several ways, including:
- Improving ability to recognize personal BG symptoms
- Increasing accurate detection of low and high BG levels
- Reducing the frequency of low and high BG readings
- Lowering risk for episodes of severe hypoglycemia
- Improving quality of life
- Lowering fear and worry about hypoglycemia
- Decreasing number of automobile accidents and violations
We will discuss the results of the BGAT studies in a future issue.
Like BGAT, BGATHome may be particularly useful for certain people. It is thought that individuals who might benefit most include those with reduced hypoglycemic awareness, frequent or recurrent episodes of hypoglycemia, a history of automobile accidents related to hypoglycemia or a high level of fear or worry about hypoglycemia. In addition, individuals who have problems with recurrent DKA or extreme hyperglycemia may benefit.