Severe hypoglycemia remains a major complication of glucose-lowering therapy in adults with type 2 diabetes mellitus (T2DM), particularly among individuals treated with insulin or sulfonylureas. Although psychoeducational interventions reduce severe hypoglycemia in type 1 diabetes, evidence in T2DM remains limited. A randomized trial published in Journal of General Internal Medicine evaluated whether adding psychoeducational training to proactive nurse care management could further reduce severe hypoglycemia in adults with T2DM.
The Preventing Severe Hypoglycemia in Adults with Type 2 Diabetes (PHT2) trial compared proactive nurse care management alone (PC) with proactive care augmented by the My Hypo Compass psychoeducational intervention (PC+). Eligible participants included adults with T2DM receiving insulin or sulfonylureas who had experienced severe hypoglycemia within the previous 12 months or had impaired awareness of hypoglycemia.
Among 259 enrolled participants, 230 (92%) completed the trial. The mean age was 67.2 ± 10.6 years, and 61% were women. The primary outcome was self-reported severe hypoglycemia during the 12-month follow-up period, assessed at 14 months.
Findings
- At baseline, 34.1% of participants in the PC group and 24.8% in the PC+ group reported at least one severe hypoglycemia event during the previous 12 months.
- At 14 months, severe hypoglycemia rates did not significantly differ between groups (16.1% in the PC group vs 11.6% in the PC+ group; adjusted relative risk [aRR] 0.72; 95% CI, 0.39-1.30).
- Level 2 hypoglycemic events (glucose <54 mg/dL for ≥15 minutes) were less frequent in the PC+ group on the absolute risk scale (adjusted absolute risk difference −11.3%; 95% CI, −21.7 to −0.8).
- No significant differences were observed between groups for other secondary outcomes.
Adding psychoeducational training to proactive care did not significantly reduce severe hypoglycemia compared with proactive care alone, although both groups experienced substantial reductions in severe hypoglycemia during follow-up.
