Cross Cultural Studies: Severe Hypoglycemia 
     Agency: NIH / Fogarty International Center 

     Principal Investigators: 
     Daniel J. Cox, Ph.D., University of Virginia 
     Dragomir Koev, Ph.D., Diabet Clinics, Bulgaria

U.S. studies document that severe hypoglicemia (SH) affects 15% of adults with insulin dependent diabets per year. This can lead to psychological distress, accidents, seizures, brain damage and even death. With improved metabolic control, the incidence of hypoglycemia approximately triples. The preliminary data suggest that the occurrence of SH may be much higher in countries where patients with Type I diabets do not have routine access to home blood glucose (BG) monitoring.
The parent grant (7/95-6/99), investigating risk factors for the occurrence of SH among adults with Type I diabets, developed, applied and evaluated a treatment program to reduce such risk factors and prevent the occurrence of SH. We propose parallel effort in Bulgaria, a country with much higher incidentce of SH, with patients who do not have access to routine home BG monitoring, but with both a sophisticated patient population and medical management.
This project has three advantages to the parent grant:
test external validity of parent grant's findings
test the original model in a situation unavailable to U.S. researchers, i.e. a patient population who do not have routine access to home BG monitoring
provede clinical and scientific input to our research and from a divergent perspective our Bulgarian colleagues
Advantages to our Bulgarian collaborators are that it would establish a network of researchers with common interests within Bulgaria, lead to the development of an effective intervention to reduse the risk of SH within  the constraints of their medical resources and potencially demonstrate the necessity for interventions that can prevent SH. The feasibility of this study is reflected in the fact that we have two Bulgarian investigators on our University in Virginia staff, that we have five outstanding Bulgarian researchers/ clinicians in Bulgarian who are eager to participate, and that we have already collaborated on a successful survey stidy.