Abstract
ObjectivePatients may fear the symptoms and consequences associated with hypoglycemia. We tested whether fear of hypoglycemia is independently associated with poorer health-related quality of life (HRQOL).Research design and methodsData were collected using direct-mail survey and enrollment information from adult commercial health plan enrollees with type 2 diabetes during a 12-month period (12/01/2008 to 11/30/2009). HRQOL was evaluated by the EuroQol (EQ)–5D index and 12-item Short Form Health Survey Mental Component Summary (SF-12 MCS) and Physical Component Summary (SF-12 PCS). Fear of hypoglycemia was assessed using the Hypoglycemia Fear Survey (HFS). Two ordinary least-squares (OLS) models of HRQOL controlling for demographics and illness characteristics were specified, and OLS regression coefficients and statistical inferences were compared. Model 1 included 1 variable of hypoglycemia symptoms; Model 2 included both hypoglycemia symptoms and HFS score.ResultsOf 3999 patients contacted, 813 responded to the survey. Model 1: hypoglycemia symptoms alone were associated with worse HRQOL (SF-12 MCS and SF-12 PCS scores and EQ-5D utility score; all P < 0.05). Model 2: hypoglycemia symptoms were significantly associated only with SF-12 MCS score. HFS total score was significantly associated with all 3 HRQOL scores. Hypoglycemia symptoms, Hispanic ethnicity, and longer diabetes duration were associated with greater hypoglycemia fear. Higher income, white race, and treatment without sulfonylurea or insulin were associated with less hypoglycemia fear (all P < 0.05).ConclusionsIn addition to the effect of symptomatic hypoglycemia on HRQOL, fear of hypoglycemia was independently associated with lower overall health status and mental and physical health.Electronic supplementary materialThe online version of this article (doi:10.1186/s12955-014-0167-3) contains supplementary material, which is available to authorized users.
Highlights
Model 1: hypoglycemia symptoms alone were associated with worse health-related quality of life (HRQOL) (SF-12 Mental Component Summary (MCS) and SF-12 Physical Component Summary (PCS) scores and EQ-5D utility score; all P < 0.05)
Hypoglycemia Fear Survey (HFS) total score was significantly associated with all 3 HRQOL scores
In addition to the effect of symptomatic hypoglycemia on HRQOL, fear of hypoglycemia was independently associated with lower overall health status and mental and physical health
Summary
Detailed methodology for this cross-sectional observational research study was previously published [16]. The study combined patient-reported data collected through mail surveys and retrospective analysis of administrative claims data (medical data, pharmacy data, and enrollment information) from a large US health plan (the Life Sciences Research Database). Due to the fact that the patients in our study were identified from administrative claims data, the study concept was approved by the large US health plan prior to commencement of the study. Participants were adult enrollees in the health plan with a diagnosis of type 2 diabetes and ≥2 pharmacy claims for an oral antidiabetic medication (OAD) with or without insulin identified in the administrative claims data from December 1, 2008, to November 30, 2009. The patient survey assessed demographic variables, age at time of type 2 diabetes diagnosis, family history of diabetes, and smoking status. Medication adherence was assessed using the Morisky self-report medication adherence 4-item questionnaire [17]
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