Blood Glucose Awareness Training: What Is It, Where Is It, and Where Is It Going?

  1. Daniel J. Cox, PhD, ABPP,
  2. Linda Gonder-Frederick, PhD,
  3. Lee Ritterband, PhD,
  4. Kushal Patel, PhD,
  5. Hartmut Schächinger, MD,
  6. Gabriele Fehm-Wolfsdorf, PhD,
  7. Norbert Hermanns, PhD,
  8. Frank Snoek, PhD,
  9. John Zrebiec, MSW, CDE,
  10. William Polonsky, PhD, CDE,
  11. David Schlundt, PhD,
  12. Boris Kovatchev, PhD and
  13. William Clarke, MD
  1. Address correspondence to Daniel J. Cox, PhD, Center for Behavioral Medicine Research, Box 800223, University of Virginia Health System, Charlottesville, VA 22908.


Management of type 1 diabetes requires a continual balancing of insulin, fuel intake, and metabolic demand (e.g., exercise). This can only be accomplished with knowledge of where one's blood glucose is and where it is going and knowledge of how to manipulate insulin, fuel, and exercise to manage it. Blood Glucose Awareness Training (BGAT) is a psychoeducational intervention that in part addresses these needs. Fifteen research studies from the United States and Europe, involving single-site and multicenter projects, are reviewed. BGAT has been consistently demonstrated to improve the ability to detect and diminish both hypoglycemia and hyperglycemia while reducing the sequelae of extreme blood glucose levels (e.g., episodes of severe hypoglycemia and driving mishaps). BGAT has recently been transformed for internet delivery, making it available both for clinicians to use with their patients and for individuals with type 1 diabetes to pursue as a self-directed tutorial.


  • Daniel J. Cox, PhD, ABPP, and William Clarke, MD, are professors; Linda Gonder-Frederick, PhD, Lee Ritterband, PhD, and Boris Kovatchev, PhD, are associate professors; and Kushal Patel, PhD, is a postdoctoral fellow at the University of Virginia Health System in Charlottesville, Va. Hartmut Schächinger, MD, is a professor at the Graduate School of Psychobiology, University of Trier, Germany. Gabriele Fehm-Wolfsdorf, PhD, is a professor at the University of Luebeck, Germany. Norbert Hermanns, PhD, is head of the Research Institute of the Diabetes Academy, Mergentheim, Germany. Frank Snoek, PhD, is a professor at the Vrije Universiteit Medical Centre in Amsterdam. John Zrebiec, MSW, is a lecturer in psychiatry at Harvard Medical School in Boston, Mass. William Polonsky, PhD,CDE, is an associate clinical professor at the University of California, San Diego. David Schlundt, PhD, is an associate professor at Vanderbilt University in Nashville, Tenn.

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