Fear of hypoglycemia: relationship to hypoglycemic risk and psychological factors

Abstract

Objective The major aims of this study were to examine (1) the association between fear of hypoglycemia (FOH) in adults with type 1 diabetes with demographic, psychological (anxiety and depression), and disease-specific clinical factors (hypoglycemia history and unawareness, A 1c), including severe hypoglycemia (SH), and (2) differences in patient subgroups categorized by level of FOH and risk of SH. Research design and methods Questionnaires were mailed to 764 patients with type 1 diabetes including the Swedish translation of the Hypoglycemia Fear Survey (HFS) and other psychological measures including the Perceived Stress Scale, Hospital Anxiety and Depression Scale, Anxiety Sensitivity Index, Social Phobia Scale, and Fear of Complications Scale. A questionnaire to assess hypoglycemia history was also included and A 1c measures were obtained from medical records. Statistical analyses included univariate approaches, multiple stepwise linear regressions, Chi-square t tests, and ANOVAs. Results Regressions showed that several clinical factors (SH history, frequency of nocturnal hypoglycemia, selfmonitoring) were significantly associated with FOH but R 2 increased from 16.25 to 39.2 % when anxiety measures were added to the model. When patients were categorized by level of FOH (low, high) and SH risk (low, high), subgroups showed significant differences in non-diabetesrelated anxiety, hypoglycemia history, self-monitoring, and glycemic control. Conclusion There is a strong link between FOH and nondiabetes-related anxiety, as well as hypoglycemia history. Comparison of patient subgroups categorized according to level of FOH and SH risk demonstrated the complexity of FOH and identified important differences in psychological and clinical variables, which have implications for clinical interventions. Keywords Type 1 diabetes Á Hypoglycemia Á Fear of hypoglycemia Á Severe hypoglycemia Á Psychological factors It is well known that depression and anxiety are more prevalent in patients with type 1 diabetes compared to subject without diabetes [1-3] and that psychological Managed by Antonio Secchi.

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“…5 Past experience of SH is associated with greater fear of hypoglycaemia (FoH) in individuals with type 1 diabetes, suggesting that the experience of hypoglycaemia plays an important role in triggering FoH. 2,[6][7][8][9] FoH is recognized as a complex and common phenomenon affecting quality of life and diabetes management for individuals with type 1 diabetes. 9 Furthermore, worries about hypoglycaemia are also common in family members.…”

“…11 Furthermore, other associations have been shown between FoH diabetes-related quality of life and psychological well-being 12 and personality traits such as anxiety. 7,13 FoH is greater at night and may contribute to poor sleep quality. …”