SYMPTOM EXPERIENCES AND GLYCEMIC CONTROL

现在已经积累了相当多的证据表明，慢性高血糖症是 与微血管发展风险增加相关 胰岛素依赖型糖尿病的并发症。因此， 越来越多地关注强化胰岛素治疗的使用 改善血糖控制接近非糖尿病患者的策略 为了降低发病率或减缓进展， 并发症然而，研究表明，改善血糖控制 导致严重低血糖的频率增加。因此，有一个 迫切需要开发胰岛素治疗患者的方法- 依赖性糖尿病（IDDM），导致血糖控制改善， 降低低血糖的风险。我们之前的研究表明， 患者利用他们对与疾病相关的症状的感知， 低血糖和高血糖，以判断自我治疗 然而，我们目前项目的发现突出了以下信息的不准确性： 患者根据症状判断其血糖水平， 并表明不准确的部分原因是自主症状的丧失 在低血糖期间。现在，我们建议测试一个行为训练项目 旨在提高患者检测与以下疾病相关症状的能力 葡萄糖水平突然变化。行为程序将被测试 在最重要的情况下，当强化胰岛素治疗时， 帮助患者在接近正常血糖水平时实现血糖控制。 没有IDDM的人。将随机抽取80名患者 分配到两种治疗条件之一：1）血糖意识 培训（BGAT）加强化胰岛素治疗; 2）对照教育 强化胰岛素治疗。将使用以下指标对患者进行评价 低血糖胰岛素钳夹技术在基线前 随机分组和强化胰岛素治疗后4个月， 教育计划实施后。我们的分析将检查 低血糖检测准确性的组间差异 胰岛素钳夹术我们还将比较治疗组， 血糖读数低于2.8 mmol/L的频率术语，患者 能够在实际现场检测低血糖和高血糖 条件、生活质量和对低血糖的恐惧。如果我们发现 症状意识计划提高了患者检测 急性血糖变化，那么我们计划在项目的下一阶段， 在一段较长的时间内跟踪患者，以检查BGAT是否 改变与损失相关的低血糖事件的发生率 意识，癫痫，或事故，或需要帮助的事件， 从而提高强化胰岛素治疗的安全性。

Considerable evidence has now accumulated that chronic hyperglycemia is associated with increased risk for the development of microvascular complications of insulin-dependent diabetes mellitus. Consequently, there has been an increased focus on the use of intensive insulin treatment strategies to improve glycemic control near those of non-diabetic individuals in order to decrease the incidence or slow the progression of complications. However, studies have shown that improved glycemic control leads to an increased frequency of severe hypoglycemia. Thus, there is a critical need to develop approaches to treatment of patients with insulin- dependent diabetes (IDDM) that lead to improved glycemic control while decreasing the risk for hypoglycemia. Our prior studies have shown that patients use their perceptions about their symptoms associated with hypoglycemia and hyperglycemia to make judgements about self-treatment However, findings from our current project highlight the inaccuracies of patient judgements about their blood glucose level based upon symptoms, and show that inaccuracy is in part due to loss of autonomic symptoms during hypoglycemia. Now, we propose to test a behavioral training program designed to increase patient ability to detect symptoms associated with sudden shifts in glucose level. The behavioral program will be tested under conditions of maximal importance, when intensive insulin treatment is being instituted to help patients achieve glycemic control near the range of individuals without IDDM. Eighty patients will be randomly assigned to one of two treatment conditions: 1) Blood Glucose Awareness Training (BGAT) plus intensive insulin treatment; 2) a control education program plus intensive insulin treatment. Patients will be evaluated using the hypoglycemic insulin clamp technique at baseline prior to randomization and four months after intensive insulin treatment and the education programs after been instituted. Our analyses will examine between-groups differences in accuracy of detection of hypoglycemia during the insulin clamp procedure. We will also compare the treatment groups in terms of frequency of blood glucose readings below 2.8 mmol/L, patient ability to detect hypoglycemia and hyperglycemia in actual field conditions, quality of life, and fear of hypoglycemia. If we find that the symptom awareness program leads to improved patient ability to detect acute glucose shifts, then we plan in the next phase of the project to follow patients over an extended period of time to examine whether BGAT alters the incidence of hypoglycemic events which are associated with loss of consciousness, seizures, or accidents, or events requiring assistance, thereby improving the safety of intensive insulin therapy.