30% of adults with type 1 diabetes have high fear of hypoglycemia
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BALTIMORE — About 30% of adults with type 1 diabetes participating in a novel screener survey had a high fear of hypoglycemia, and those with fear of hypoglycemia had higher HbA1c and more frequent severe hypoglycemic events.
In findings presented at the Association of Diabetes Care & Educational Specialists Annual Conference, researchers developed a nine-item screening tool to assess fear of hypoglycemia in adults with type 1 diabetes across two domains: worry and behavior. Of the study participants, 30% had a high fear of hypoglycemia total score. This rate of high fear of hypoglycemia is similar to the national average published in other literature, according to Nicole Rioles, MA, senior director of clinical partnerships for T1D Exchange in Boston.
“This is a brief screener that can be incorporated into routine practice the same way that clinics have increased screening for depression,” Rioles told Healio. “The screener can be part of pre-visit screening through the patient portal to save time and be better prepared for the visit to identify patient needs, including referrals for behavioral mental health services. The screener can be used for both in-person and telehealth visits.”
Rioles and colleagues recruited 553 adults aged 18 years and older who were living with type 1 diabetes for at least 1 year from three clinics in the T1D Exchange Quality Improvement Collaborative. Participants completed the fear of hypoglycemia screening tool (mean age, 38.9 years; 64.6% women; 88.4% white). The nine-item screener includes six questions for assessing fear of having low blood glucose and three questions related to overeating, lack of physical activity and keeping glucose levels high to avoid hypoglycemia. Responses were provided on a 5-point Likert scale and ranged from 1 point for strongly disagree to 5 points for strongly agree. A higher score indicated greater fear of hypoglycemia. Participants self-reported demographics and diabetes characteristics, including HbA1c, glucose monitoring and insulin delivery methods, low- and high-bound glucose levels and number of severe hypoglycemic events. Impaired awareness of hypoglycemia was measured by Gold score.
Of the study cohort, 30% had a high fear of hypoglycemia total score of 31 to 44 points, 24% had a high score of 24 to 30 points on the worry subscale, and 28% had a high behavior subscale score of 10 to 15 points. In multiple regression analysis, participants with a high total fear of hypoglycemia score were more likely to have a higher self-reported HbA1c (beta = 0.559; P < .001), more comorbidities (beta = 1.085; P < .001) and a higher low-bound blood glucose level (beta = 5.313; P < .01) than those with a low fear of hypoglycemia score.
In an analysis of responses, most participants agreed or strongly agreed that they experienced fear of hypoglycemia while driving, sleeping, out in public or alone. The majority of the cohort also stated they ate more than they needed to avoid low blood glucose levels.
“Patients with fear of hypoglycemia may restrict their activities or use compensatory behaviors to avoid hypoglycemia,” Rioles said. “Fear of hypoglycemia negatively impacts patients’ quality of life, psychological well-being and management of diabetes.”
Higher fear of hypoglycemia score was positively correlated with higher low-bound blood glucose (r = 0.15), higher Gold score (r = 0.11), more frequent severe hypoglycemia events (r = 0.09) and higher BMI (r = 0.09). High fear of hypoglycemia was negatively correlated with younger age (r = –0.09) and lower diabetes duration (r = –0.17).
Rioles said future research could examine a potential pilot that supports implementing the screener in real-world practice. She added researchers could look at expanding the screener to include adults with type 2 diabetes.
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Peter M, et al. IP13. Presented at: ADCES22; Aug. 12-15, 2022; Baltimore.
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