390-P: Household Food Security and Fear of Hypoglycemia in Youth and Young Adults with Diabetes and Parents of Youth with Diabetes

Abstract

Hypoglycemia is a common acute complication in diabetes that is often treated with carbohydrate-rich snacks or drinks. For individuals with diabetes and household food insecurity (HFI), uncertain availability of food may increase fear of hypoglycemia (FOH). FOH may prevent individuals from optimal diabetes management. We analyzed data from 1,603 adult (≥18 years, mean 23.7 years, 80% type 1 diabetes [T1D], 20% type 2 diabetes [T2D]) and 592 youth (10.0-17.9 years, mean 15.2 years, 100% T1D) participants in the SEARCH for Diabetes in Youth Study. Adult participants and parents of youth participants completed the U.S. Household Food Security Survey, where ≥3 food insecure conditions or behaviors indicate HFI. Adults, youth, and parents of youth completed the Hypoglycemia Fear Survey that provides a behavior subscale (scores 0-60), worry subscale (scores 0-72), and total score (sum of subscales). We examined the association of HFI with FOH with general linear models, adjusting for socioeconomic, demographic, and clinical covariates. Approximately 20% of adults and 17% of youth had HFI. Adults with T1D reporting HFI (vs. no HFI) had increased FOH (+3 units for behavior, +11 units for worry, +14 units for total), after adjustment for covariates (all p<0.0001). Parents of youth with T1D reporting HFI had a 3 unit increase in worry FOH (p=0.03). Adults with T2D reporting HFI had increased FOH (+8.9 units for total, +6 units for worry; all p<0.01). Youth with T1D reporting HFI did not differ in FOH than those not reporting HFI. This research suggests that among adults with diabetes and parents of youth with T1D, those with HFI are more likely to experience FOH than those without HFI. Implementation of common approaches to ameliorate risk of hypoglycemia such as carrying snacks is problematic for people who are food insecure. Providers could consider HFI when discussing hypoglycemia and fear thereof with their patients. Disclosure L.A. Reid: None. S. Zheng: None. J.A. Mendoza: None. B.A. Reboussin: None. K.A. Sauder: None. S. Saydah: None. J.M. Lawrence: None. E.T. Jensen: None. L. Henkin: None. K. Flory: None. L.M. Knight: None. C. Pihoker: None. L.M. Dolan: None. A.D. Liese: None. Funding National Institutes of Health (1UC4DK108173, 1R01DK117461-01)