Fear of hypoglycaemia in paediatric diabetes: a literature review

Abstract

Background: Type 1 diabetes mellitus is one of the most common chronic childhood illnesses and, despite ongoing technological advances, hypoglycaemia remains an inevitable therapeutic risk. Hypoglycaemia results in unpleasant physiological outcomes, social embarrassment and – in extremis – life-threatening consequences. Overlying this inescapable clinical risk is a fear of this risk, ranging from fleeting to overwhelming, and substantially impacting the trajectory of diabetes.Aim: The aim of this literature review is to identify, summarise and critically appraise works pertaining to the development, impact and management of paediatric fear of hypoglycaemia (FoH).Methods: A search was conducted on Embase, MEDLINE and PsycINFO for studies published between 2000 and 2020, with cross-referencing searches for articles not detected in the original keyword search. Study quality was assessed using recognised tools, and relevant data were extracted systematically.Results: Forty-three studies met the inclusion criteria. FoH was a moderate problem throughout the studies, increased by a history of hypoglycaemia and predisposition to psychological stress. There was conflicting evidence on the influence of age, diabetes duration, technology and parental demographics. Some studies showed a significant impact on glycaemic control and quality of life (QoL), more consistently for the latter. Only 13 intervention trials were included, showing mixed success with cutting-edge technology, and decent gains with psychological interventions.Conclusions: FoH is clearly a ubiquitous issue among some families with type 1 diabetes. Prospective longitudinal studies are required to assess potential risk factors at diagnosis, monitor for the development of FoH at regular intervals, and enable a more comprehensive assessment of the long-term impact on glycaemic control and QoL. Further randomised controlled trials must demonstrate the value of technological and psychological therapies in order to make such interventions commonplace offerings for families suffering from intractable fear.