Trials Show BGAT Delivered Online a Success! But Don't Celebrate Just Yet

Blood Glucose Awareness Training (also known as “BGAT”) is, perhaps, one of the most important pieces of diabetes education that miraculously, an overwhelming majority of certified diabetes educators (CDEs) have never even heard of. It should be required education, but sadly, is not and in my personal experience, many CDEs have never even heard of the program.

Now I must admit, when I was diagnosed at age 7 back in 1976, there was no such thing as a “CDE” and truthfully, I have never viewed that “certification” as having any particular value. My reason is not without merit. But my core theme today is not about CDEs or their ignorance about BGAT (even though I think that’s inexcusable), but it pertains to Blood Glucose Awareness Training. There is a detailed review of BGAT which can be found in the Diabetes Care archives (see here for the article).

What is BGAT?

Well, if you suffer from impaired hypoglycemia awareness, then this training could quite literally save your life!

Last year, I hosted an online chat with Linda Gonder-Frederick, and as I recall, the number of participants was far greater than expected. This suggests to me that this is an area of tremendous interest that professional organizations like the American Association of Diabetes Educators (AADE) are closing their eyes and ears to.

When I recently asked Linda about BGAT-Home, the online version of the program which could potentially bring this valuable training to people all over. She responded by writing:

"Okay … the internet version of BGAT. We are in the final stages of testing it and will be presenting our results at this year’s ADA meeting. We have a website where people can go to put their names if they are interested in being notified as soon as we are ‘up and running.’ It has taken us a long time. My computer savvy colleague said that he needs to update it, and he will get to it this week. But you can enter your name now."

This past August, the diabetes journal Diabetes Care reported on the trial result for BGAT-Home. In the new study, researchers looked at whether an online program in “blood glucose awareness training” could help type 1 diabetics better manage their disease.

The program, now dubbed “BGAThome”, is an adaptation of well-studied program that uses group sessions to teach people with diabetes (particularly those with type 1) tactics for predicting and preventing blood sugar ups-and-downs.

The Internet version of the program is designed to allow patients to improve their diabetes management from the privacy of their own home, Dr. Daniel Cox, the lead researcher on the study, told Reuters Health. The authors note that BGAT was converted for web-based delivery. They note that the internet allows BGAT delivery to be dynamic, engaging, convenient, and personalized. Efficacy was evaluated using a 2 (BGAThome, n=20, vs. control, n=20) x 2 (pre/post) design. They conclude that BGAThome was judged as useful and easy to use, was completed by 94% of the participants, and resulted in significant clinical improvements (P<0.05).

So here’s the deal:

In a follow-up conversation I had with Linda Gonder-Frederick, she told me that they were actually having a conference call with the ADA to discuss the possible role they might play in making BGATHome available nationwide. The crux of the matter is that they need financial backing to update and upgrade the system so that it can “handle” large numbers of users. These are really issues that are largely technical in nature, and the ADA certainly should be able to pony up the cash and expertise needed to address their concerns, but and they may very well do so. But I responded to Linda that if those conversations were not fruitful, we may be able to get support from JDRF or another organization. But I also said that I would try to raise attention to the issue – and that was NOT contingent on ADA support (which may or may not be forthcoming, I don’t know yet).

Interestingly, yesterday, Close Concerns featured a posting about new men’s health education campaign to help bridge the gap and reach men with diabetes. Their goal is to provide tools and resources to take a “modern” approach to managing diabetes in every day life. They closed with a note indicating they were excited about ADA’s take-charge stance on reaching out and closing the information gap for men. But they also indicated that they hope the ADA continues to be proactive and help others – particularly those falling through the cracks of diabetes care (young adult and transition support anyone?? Pregnancy? Elderly?). I responded by asking about this particular program. My feeling is that issues such as erectile dysfunction don’t need as much attention as hypoglycemia unawareness, but that hasn’t stopped the ADA from giving it priority.

This is a personal diatribe for me, namely that I think the ADA and various other diabetes establishment organizations, including the American Association of Diabetes Educators (AADE) have a very poor track record on this issue, and it’s time to stop and address a more serious issue that today, patients tend to be “blamed” for, even though the science shows that patients are not to blame for it? This is an issue patients with type 1 diabetes in particular have not done enough complaining about, but they need to be aware of the facts, first, and sadly, many are not.

The Science Is By No Means “Clear” on this issue, so let me set the record straight:

#1 Patients With Diabetes Cannot Be “Blamed” for Hypoglycemia Unawareness

#2 Patients With Diabetes May Not Be Able to “Restore” their Symptoms, Even With Vigilant Avoidance of Hypoglycemia for a Period of Time

#3 The Medical Establishment has a Very Poor Track Record on this Particular Issue

#4 There ARE programs which may be able to help, but they badly need financial assistance!

#5 Many patients, especially those I have encountered in the online world, are mis-informed on this particular issue, so caveat emptor: let the buyer beware!

#6 The 2 programs DiabetesTalkFest has hosted on this particular topic were among the best-attended programs hosted, and Linda Gonder-Frederick remains one of the most popular guests ever hosted!

Listed below are some relevant links which may be of interest which ARE factually reliable, so yes, you may rely on this information:

Blood Glucose Awareness Training (BGAT-2)

An overview of blood glucose awareness training (BGAT) has been shown to help improve awareness of blood glucose (BG) fluctuations among adults with type 1 diabetes. This study investigates the long-term (12-month) benefits of BGAT-2.


An online version of Blood Glucose Awareness Training developed by the University of Virginia Diabetes Research Team in Behavioral Medicine.

I want some of this action! I live alone (me and the cats) and my sugars can drop into the 40’s before I become aware and by then, it is sometimes hard to concentrate enough to take care of it. And then I almost always get way to many carbs and rebound way high