Fear Survey Research Articles

Unconditioned response to a naturally aversive stimulus is associated with sensitized defensive responding and self-reported fearful traits in a PTSD sample.

Unconditioned responding (UCR) to a naturally aversive stimulus is associated with defensive responding to a conditioned threat cue (CS+) and a conditioned safety cue (CS-) in trauma-exposed individuals during fear acquisition. However, the relationships of UCR with defensive responses during extinction training, posttraumatic stress disorder (PTSD) symptom severity, and fearful traits in trauma-exposed individuals are not known. In a sample of 100 trauma-exposed adults with a continuum of PTSD severity, we recorded startle responses and skin conductance responses (SCR) during fear acquisition and extinction training using a 140 psi, 250-ms air blast to the larynx as the unconditioned stimulus. We explored dimensional associations of two different measures of UCR (unconditioned startle and unconditioned SCR) with conditioned defensive responding to CS+ and CS-, conditioned fear (CS+ minus CS-), PTSD symptom severity, and a measure of fearful traits (composite of fear survey schedule, anxiety sensitivity index, and Connor-Davidson resilience scale). Unconditioned startle was positively associated with startle potentiation to the threat cue and the safety cue across both learning phases (CS+ Acquisition, CS- Acquisition, CS+ Extinction Training, CS- Extinction Training) and with fearful traits. Unconditioned SCR was positively associated with SCR to the CS+ and CS- and SCR difference score during Acquisition. Neither type of UCR was associated with PTSD symptom severity. Our findings suggest that UCR, particularly unconditioned startle to a naturally aversive stimulus, may inform research on biomarkers and treatment targets for symptoms of pervasive and persistent fear in trauma-exposed individuals.

Fasted C-Peptide Distribution and Associated Clinical Factors in Adults With Longstanding Type 1 Diabetes: Analysis of the Canadian Study of Longevity in Type 1 Diabetes

ObjectiveAlthough insulin production is reportedly retained in many people with longstanding type 1 diabetes (T1D), the magnitude and relevance of connecting peptide (C-peptide) production are uncertain. In this study, we aimed to define fasted C-peptide distributions and associated clinical factors. MethodsIn a cross-sectional analysis of the Canadian Study of Longevity, fasted serum and urinary C-peptide was measured in 74 patients with longstanding T1D (duration ≥50 years) and 75 age- and sex-matched controls. Extensive phenotyping for complications was performed and patient-reported variables were included. C-peptide distributions were analyzed, and multivariable logistic regression was used to assess the variable association in participants with T1D. ResultsThe 74 participants with T1D had a mean age of 66±8 years, a disease duration of 54 (interquartile range 52 to 58) years, and a glycated hemoglobin (A1C) of 7.4%±0.8% (56.8±9.15 mmol/mol). The 75 controls had a mean age of 65±8 years and an A1C of 5.7%±0.4% (38.4±4.05 mmol/mol). Participants with T1D had lower fasted serum C-peptide than controls (0.013±0.022 vs 1.595±1.099 nmol/L, p<0.001). Of the participants with T1D, C-peptide was detectable in 30 of 73 (41%) serum samples, 32 of 74 (43%) urine samples, and 48 of 74 (65%) for either serum or urine. The variables independently associated with detectable serum or urinary C-peptide were lower total daily insulin requirement (odds ratio 2.351 [for 1 lower unit/kg], p=0.013) and lower hypoglycemia worry score (odds ratio 1.059 [for 1 point lower on the worry subscore of the Hypoglycemia Fear Survey], p=0.030). ConclusionsAlthough detectable C-peptide in longstanding diabetes was common, the magnitude of concentration was extremely low when compared with age- and sex-matched controls. Despite minimal detectability, its presence is validated by lower insulin requirements and strongly associated with lower hypoglycemia worry.

SAT101 Patient Reported Outcomes With Closed-loop Insulin Delivery Versus Usual Care For Type 1 Diabetes: A Meta-analysis Of Randomized Controlled Trials

Abstract Disclosure: C.H. Silva: None. A. Godoi: None. E. Padrao: None. I. Reis Marques: None. A.C. Silva: None. V.C. Moreira: None. L.C. Hespanhol: None. I.A. Souza: None. C. Gomes: None. C. Oommen: None. I.A. Miyawaki: None. J.E. Loyola Júnior: None. J. De Sa: None. A. Mahesh: None. Background: Increased diabetes-related stress and burden significantly impact the ability of achieving therapeutic targets, the adherence to self-management and the quality of life of type 1 diabetic patients (T1DM). Patient reported outcomes (PRO) are being increasingly recognized for assessing the reasons for early discontinuation and incorporating therapeutic interventions in diabetes. Although the clinical efficacy of closed-loop (CL) insulin delivery patients has been brought to light in recent years, previous meta-analyses have not yet shown the long-term effects on the lived experience and treatment satisfaction of patients. Purpose: To compare quality of life and treatment satisfaction of patients using CL devices with patients continuing UC in the pediatric and adult population of T1DM. Methods: We systematically searched PubMed, Cochrane and EMBASE in October 2022 to include randomized controlled trials (RCTs) reporting PRO and comparing the long-term use (&amp;gt;12 weeks) of CL systems with usual care (UC) in type 1 diabetic children and adults. CL systems included automated pancreas, hybrid CL, and/or advanced hybrid CL. UC consisted of the use of multiple daily injections, sensor augmented pump and/or continuous glucose monitoring. PRO assessed were Diabetes Treatment Satisfaction (DTSQs), Hypoglycemia Fear Survey (HFS-II), and Problem Areas in Diabetes (PAID). Statistical analysis was performed with RevMan 5.4.1. Heterogeneity was assessed with I² statistics and random-risk effect was used if I2 &amp;gt; 50%. The protocol was registered in PROSPERO (ID: CRD42022366710). Results: We included 7 RCTs with a total of 596 patients, 335 (56.2%) in the closed-loop group and 261 (43.8%) in the usual care group. The fear of hypoglycemia was significantly lower with the use of CL systems (MD -4.31; 95% CI -8.43– -0.18; P = 0.04; I² = 0%) compared to UC. No statistically significant differences between groups were found with regards to treatment satisfaction (MD 1.27; 95% CI -2.07–4.61; P = 0.46; I² = 73%) nor in PAID (MD -4.36; 95% CI -10.62–1.89; P = 0.17; I² = 0%). Moreover, asymmetrical distributions were found in all funnel plots, possibly due to publication bias. Conclusion: In this meta-analysis of randomized trials, fear of hypoglycemia was significantly lower with the use of CL devices compared to UC. However, the groups did not significantly differ when assessing patient reported outcomes of treatment satisfaction and distress. Presentation: Saturday, June 17, 2023

The Effect of Do-It-Yourself Real-Time Continuous Glucose Monitoring on Glycemic Variables and Participant-Reported Outcomes in Adults With Type 1 Diabetes: A Randomized Crossover Trial.

Real-time continuous glucose monitoring (rtCGM) has several advantages over intermittently scanned continuous glucose monitoring (isCGM) but generally comes at a higher cost. Do-it-yourself rtCGM (DIY-rtCGM) potentially has benefits similar to those of rtCGM. This study compared outcomes in adults with type 1 diabetes using DIY-rtCGM versus isCGM. In this crossover trial, adults with type 1 diabetes were randomized to use isCGM or DIY-rtCGM for eight weeks before crossover to use the other device for eight weeks, after a four-week washout period where participants reverted back to isCGM. The primary endpoint was time in range (TIR; 3.9-10 mmol/L). Secondary endpoints included other glycemic control measures, psychosocial outcomes, and sleep quality. Sixty participants were recruited, and 52 (87%) completed follow-up. Glucose outcomes were similar in the DIY-rtCGM and isCGM groups, including TIR (53.1% vs 51.3%; mean difference -1.7% P = .593), glycosylated hemoglobin (57.0 ± 17.8 vs 61.4 ± 12.2 mmol/L; P = .593), and time in hypoglycemia <3.9 mmol/L (3.9 ± 3.8% vs 3.8 ± 4.0%; P = .947). Hypoglycemia Fear Survey total score (1.17 ± 0.52 vs 0.97 ± 0.54; P = .02) and fear of hypoglycemia score (1.18 ± 0.64 vs 0.97 ± 0.45; P = .02) were significantly higher during DIY-rtCGM versus isCGM. Diabetes Treatment Satisfaction Questionnaire status (DTSQS) score was also higher with DIY-rtCGM versus isCGM (28.7 ± 5.8 vs 26.0 ± 5.8; P = .04), whereas diabetes-related quality of life was slightly lower (DAWN2 Impact of Diabetes score: 3.11 ± 0.4 vs 3.32 ± 0.51; P = .045); sleep quality did not differ between the two groups. Although the use of DIY-rtCGM did not improve glycemic outcomes compared with isCGM, it positively impacted several patient-reported psychosocial variables. DIY-rtCGM potentially provides an alternative, cost-effective rtCGM option.

Hypoglycemia avoidance behaviour in active Qatari adults with type 1 diabetes under blood glucose monitoring device

AimsThe present study aimed to explore the relationship between fear of hypoglycemia and exercise management strategies in active Qatari adults with T1D during the COVID-19 pandemic, and to explore the potential role of continuous glucose monitoring (CGM) devices in promoting safe physical activity practices. MethodsParticipants completed the Hypoglycemia Fear Survey (HFS) questionnaire and the International Physical Activity Questionnaire (IPAQ). Out of the 102 participants, 41 were considered "active" and under CGM and were included in the analysis. ResultsMultiple linear regression analysis revealed a significant positive correlation between the behavior dimension of the HFS scores and both vigorous physical activity and MET-minutes per week (R2 adj. = 0.055; β = 0.56; p = 0.05 and R2 adj. = 0.039; β = 0.38; p = 0.04). The results showed a significant positive association between HbA1c levels and the behavior dimension of the HFS (R = 0.39, p = 0.005), as well as between the number of episodes of severe hypoglycemia and the behavior dimension (R = 0.46, p = 0.042). ConclusionThese findings highlight the need for effective strategies to manage fear of hypoglycemia and promote physical activity in individuals with T1D. The use of CGM devices may provide added safety to physical activity practices by reducing the risk of hypoglycemia.

Health-related quality of life in Chinese individuals with type 2 diabetes mellitus: a multicenter cross-sectional study

BackgroundType 2 diabetes mellitus (T2DM) is a chronic and life-threatening disease. Health-related quality of life (HRQoL) is vital for individuals with T2DM. However, little is known about the impact of psychological stability factors on HRQoL among individuals with T2DM in mainland China.MethodsThis multicenter cross-sectional study was conducted in five tertiary grade-A hospitals in Chongqing, China, from January to December 2019. A total of 385 individuals with T2DM were included by the convenient sample method. Fear of Progression (FOP) Questionnaire-short Form, Hypoglycemia Fear Survey II, diabetes-management self-efficacy scale, and EuroQol-5 Dimensions were used for data collection.ResultsThe mean age of the 385 individuals was 57.65 (SD = 15.15) years, three-quarters of whom had a high school or above education level. The participants in our study had moderate HRQoL and were more likely to have poor scores in the pain/discomfort dimension. The FOP level was moderate on average, and 23.1% of individuals suffered from psychological dysfunction. The participants had higher levels of fear of hypoglycemia (FOH) and self-efficacy (SE). Multiple steppage-regression analysis predicted that higher levels of FOP and FOH, reduced SE, older age, longer duration since diagnosis, lower educational attainment, higher levels of HbA1c, and living with comorbid conditions were related to lower HRQoL.ConclusionThis study showed that the HRQoL among Chinese T2DM patients may be impaired by increased FOP and FOH, decreased SE, and poor glycemic control. In addition, as the patient’s age and duration since diagnosis increase, their HRQoL further declines. We recommend improving HRQoL by encouraging individuals to attain more health education and resilience skills to enhance SE and reduce negative emotions among individuals with T2DM.

Translation and Validation Study of the Hypoglycemia Fear Survey in a Greek Population of Children and Adolescents with Type 1 Diabetes Mellitus and their Parents.

The present study attempted to translate and culturally adapt an established research instrument, the Hypoglycemia Fear Survey (HFS) questionnaire, to the Greek population and evaluate its validity and internal consistency so that it can be used for the assessment of hypoglycemia fear in Greek children and adolescents with T1DM and their parents. One hundred Greek children and adolescents with T1DM, 54 males, 6-18 years old, and one of their parents participated in this validation study. The participants completed the translated Greek HFS, which includes one version for children (CHFS) and one for parents (PHFS). Exploratory Factor Analysis (EFA) was used to assess construct validity. Internal consistency was assessed using Cronbach's alpha, and convergent validity was established by estimating the correlation coefficients between the scores of the HFS scales/subscales and the different constructs of the Pediatric Quality of Life Inventory. The CHFS and PHFS exhibited adequate internal consistency for the total score and the Worry subscale, but lower consistency for the Behavior subscale. High test-retest reliability was also shown. We conclude that the Greek version of the HFS is a valid and reliable instrument to assess the fear of hypoglycemia in Greek children and adolescents with T1DM and their parents.

Possible Risk Factors for Dental Fear and Anxiety in Children Who Suffered Traumatic Dental Injury.

Children who undergo painful experiences such as traumatic dental injury (TDI) during their early years are more likely to be at an increased risk of developing dental fear and anxiety (DFA). The purpose of this study was to identify potential risk factors for DFA of these children. The study participants were 220 parents/caregivers and their children who experienced TDI. Their socio-demographic backgrounds were investigated with the modified WHO Oral Health Questionnaire for Children that included questions about parents' knowledge and attitudes, while the DFA level was determined using the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) and the Simplified Oral Hygiene Index (OHI-S Index) was used to assess oral hygiene status. The confirmed risk factors are parental knowledge, female gender, and degree of oral hygiene and pain in the last three months, while age, type of TDI, presence of soft-tissue injury, and number of subjective complaints were not confirmed. The overall model predicted approximately 54% of variance in DFA, R2 = 0.545, F (4.215) = 64.28 p < 0.001. These findings emphasise the importance of addressing pain management, improving oral hygiene, and enhancing parental knowledge to mitigate DFA in children with TDIs.

Effect of diabetes technologies on the fear of hypoglycaemia among people living with type 1 diabetes: a systematic review and meta-analysis

Fear of hypoglycaemia (FOH) significantly disrupts the daily management of type 1 diabetes (T1D) and increases the risk of complications. Recent technological advances can improve glucose metrics and reduce hypoglycaemia frequency, yet their impact on FOH is unclear. This systematic review and meta-analysis (SRMA) aimed to synthesize the current literature to understand the impact of diabetes technologies on FOH in T1D. In this SRMA, we searched PubMed, Medline, Scopus, and Web of Science from inception up to May 21st, 2023 for studies assessing the effect of using real-time or intermittently scanned continuous glucose monitors (rtCGM or isCGM); insulin pumps (CSII); and their combinations on FOH as the primary outcome, measured using the Hypoglycaemia Fear Survey (HFS; including total, worries [HFS-W], and behaviours [HFS-B] scores), in non-pregnant adults with T1D. Data was extracted by the first and second authors. Results were pooled using a random-effects model based on study design (RCT and non-RCT), with subgroup analysis based on the type of technology, reported change in hypoglycaemia frequency, and duration of use. Risk of bias was evaluated with Cochrane and Joanna Briggs Institute tools. This study is registered with PROSPERO, CRD42021253618. A total of 51 studies (n=8966) were included, 22 of which were RCTs. Studies on rtCGM and CSII reported lower FOH levels with ≥8 weeks of use. Studies on CSII and rtCGM combinations reported lower FOH levels after ≥13 weeks of automated insulin delivery (AID) use or 26 weeks of sensor-augmented pump (SAP) use. The meta-analysis showed an overall lower FOH with technologies, specifically for the HFS-W subscale. The RCT meta-analysis showed lower HFS-W scores with rtCGM use (standard mean difference [95%CI]:-0.14 [-0.23,-0.05], I2=0%) and AID (-0.17 [-0.33,-0.01], I2=0%). Results from non-RCT studies show that SAP users (-0.33 [-0.38,-0.27], I2=0%) and rtCGM users (-0.38 [-0.61,-0.14], I2=0%) had lower HFS-W. We found consistent, yet small to moderate, effects supporting that diabetes technologies (specifically rtCGM, SAP, and AID) may reduce hypoglycaemia-related worries in adults with T1D. Current literature, however, has limitations including discrepancies in baseline characteristics and limited, mainly descriptive, statistical analysis. Thus, future studies should assess FOH as a primary outcome, use validated surveys, and appropriate statistical analysis to evaluate the clinical impacts of technology use beyond just glucose metrics. Canadian Institutes of Health Research, Juvenile Diabetes Research Foundation Ltd.

Metabolic control and incidence of hypoglycaemia, hospitalisation and complications among Saudi patients with type 2 diabetes initiating second-line therapy: an analysis of the Saudi Arabia data from the DISCOVER Observational Study programme

ObjectivesThe aim of the global DISCOVERing Treatment Reality of Type 2 Diabetes in Real World Settings (DISCOVER) Study was to provide a comprehensive real world assessment of the treatment pattern...

Validity and reliability of the hypoglycemia confidence scale for patients with type 1 diabetes

Background: This study aims to assess the validation and reliability of the Turkish adaptation of the Hypoglycemic Confident Scale and to investigate its relationship between the Hypoglycemia Fear survey, WHO Well-Being Index, Hba1c, sociodemographic characteristics and variables.&#x0D; Methods: The survey consists of a total of 81 questions concerning the sociodemographic status, clinic status variables, and the Hypoglycemic Confidence Scale formed by 35 standard questions and 46 scale questions. &#x0D; Result: In this study, assessment of the reliability of the scale was achieved by internal consistency and test-retest methods, and the Cronbach alpha internal consistency reliability coefficients were 0.814 in the first test and 0.885 in the second test. It was observed that the responses given to the items of the Hypoglycemic Confidence Scale at two separate times were consistent with one another. The overall correlation of the scale (r = 0.927, p &lt; 0.0001) was positive and highly significant (p &lt; 0001). A significant, inverse, and moderate correlation was found between HbA1c values and Hypoglycemic Confidence Scale total scores (p &lt; 0,0001, r = -0,479). Similarly, a higher hypoglycemic confidence score was observed to be associated with higher WHO Well-Being Index score and lower hypoglycemic fear. &#x0D; Conclusion: This study shows that the Hypoglycemia Confidence Scale created by Polonsky et al. is a valid and reliable scale that can be put into use in our country.1 The Hypoglycemic Confidence Scale may be beneficial in diabetic patient follow-up and achieving treatment goals in diabetic patients.

Identification of factors associated with fear of hypoglycemia using the capability, opportunity, motivation and behavior model in people with type 2 diabetes mellitus: a cross-sectional study.

To examined the relationship between fear of hypoglycemia and certain variables in people with type 2 diabetes mellitus (T2DM) based on the Capability, Opportunity, Motivation, and Behavior model, combined with the context unique to people with diabetes to provide a basis for developing targeted nursing interventions. In this cross-sectional study, 212 people with T2DM were recruited from February 2021 to July 2021. Data were collected using the Hypoglycaemia Fear Survey, Gold score, Patient Assessment of Chronic Illness Care (PACIC) scale and Diabetic Self-Management Attitudes Scale. Multiple linear regression analysis was performed to determine the predictors of fear of hypoglycemia using SPSS 26.0. The mean fear of hypoglycemia score was 74.88 ± 18.28 (range: 37.00-132.00). In people with T2DM, the frequency of blood glucose monitoring, the frequency of hypoglycemia in the past half-year, degree of understanding of hypoglycemia, impaired awareness of hypoglycemia, PACIC, and self-management attitude of diabetes were the influencing factors of fear of hypoglycemia (adjusted R2 = 0.560, F[21,190] = 13.800, P < 0.001). These variables explained 56.0% of the variance in the fear of hypoglycemia. The level of fear of hypoglycemia in people with T2DM was relatively high. In addition to paying attention to the disease characteristics of people with T2DM, medical staff should also pay attention to patients' own perception and handling ability of disease and hypoglycemia, attitude toward self-management behavior and external environment support, all of which have a positive effect on improving the fear of hypoglycemia in people with T2DM, optimizing the self-management level and improving quality of life.

1794-PUB: Potential for Improving CGM Systems? Anticipated Benefits from Increasing the Glucose Prediction of Current CGM Algorithms

Current CGM algorithms allow a glucose prediction up to 30 minutes. To elaborate on the potential to improve current CGM systems, we investigated if a possible increase in this prediction window to up to 2 hours would be perceived as a significant benefit. People with type 1 and type 2 diabetes currently using a CGM system were invited to participate. Participants were presented with a scenario depicting the potential of a hypothetical CGM algorithm to predict the course of glucose for up to 2 hours. They were instructed to imagine how such a long-term prediction would affect their diabetes management. They were asked to complete the T1-Diabetes Distress Scale (T1-DDS) and the Hypoglycemia Fear Survey (HFS-II) and rate each item regarding the perceived potential change from using such a long-term prediction (scale: -2 strong deterioration, -1 deterioration, 0 no change, 1 improvement, 2 strong improvement). 206 people participated (29.1% type 2 diabetes). Participants expected moderate improvements in hypoglycemia and management distress (Box plots shown in Figure 1 for T1-DDS). Similar improvements in HFS-II scores (0.57±0,49) were seen with no differences between diabetes types. Increasing the glucose prediction to up to 2 hours would be seen as a potential improvement regarding reductions in hypoglycemia distress and fear of hypoglycemia by both people with type 1 and type 2 diabetes. Disclosure D.Ehrmann: Advisory Panel; Roche Diabetes Care, mySugr, Dexcom, Inc., Speaker's Bureau; Berlin-Chemie AG, Dexcom, Inc. T.Glatzer: Employee; Roche Diabetes Care, Berlin-Chemie AG. L.Priesterroth: Speaker's Bureau; Ypsomed AG. B.Olesen: Advisory Panel; AstraZeneca, Evivamed, Berlin-Chemie AG, Speaker's Bureau; Medtronic, Medtrixx. B.Kulzer: Advisory Panel; Berlin-Chemie AG, Abbott Diabetes, Bayer Inc., Dexcom, Inc., Novo Nordisk, Insulet Corporation, embecta, Research Support; Sanofi, Roche Diabetes Care. N.Hermanns: Advisory Panel; Insulet Corporation, Research Support; Sanofi-Aventis Deutschland GmbH, Roche Diagnostics, Becton, Dickinson and Company, Speaker's Bureau; Dexcom, Inc., Berlin-Chemie AG. Funding Roche Diabetes Care

253-OR: Effect of Continuous Glucose Monitoring on Hypoglycemia, Diet Liberalization, and Quality of Life in Post-bariatric Hypoglycemia

Post-bariatric hypoglycemia (PBH), affecting up to 39% of patients with Roux-en-Y gastric bypass (RYGB), is associated with episodes of disabling hypoglycemia, chronic diet restriction and reduced quality of life (QoL). We evaluated the effects of unblinded vs blinded CGM on hypoglycemia, dietary liberalization, and QoL. 15 RYGB patients with confirmed PBH wore in random order, a Dexcom G6 Pro for 10 days blinded and 10 days unblinded with alarm set to 65 mg/dL. The Hypoglycemia Fear Survey II (HFS-II) was administered after each phase to assess hypoglycemia-based worries and behaviors. The number of hypoglycemia events &amp;lt;70, 54, and 40 mg/dL and proportion of time below each threshold was assessed (diurnal and nocturnal) and adjusted for meal intake. The number of diurnal hypoglycemic events &amp;lt;40 and &amp;lt;54 mg/dL were reduced by 66% and 25% respectively, and proportion of time was reduced by 71% and 50% respectively during unblinded vs blinded CGM use, though neither measure reached statistical significance. Diet liberalization was significantly greater during unblinded CGM use (54 vs 45 glucose spikes/10-day period, p=0.012). HFS-II showed improvement in 16/19 worry measures, reaching statistical significance in six. CGM use in patients with PBH enabled diet liberalization, reduced hypoglycemia-based worries, and reduced diurnal hypoglycemia, indicating improved QoL. Disclosure S.Ramanujan: None. N.Turk: None. E.M.Ayhan: None. C.M.Craig: Employee; Eiger BioPharmaceuticals, Stock/Shareholder; Eiger BioPharmaceuticals. T.Mclaughlin: Board Member; January, Inc., Research Support; Merck &amp; Co., Inc., Stock/Shareholder; Eiger Bio. Funding American Diabetes Association (1-19-ICTS-073 to T.M.)

904-P: 12-Month Treatment Satisfaction (TS) and Fear of Hypoglycemia (FoH) Outcomes in the ADAPT Study—A Randomized Controlled Trial Comparing an Advanced Hybrid Closed-Loop System (AHCL) to Multiple Daily Injections (MDI) with Intermittently Scanned CGM (isCGM)

Objective: To assess whether TS &amp; FoH improvements achieved with the MiniMed™ 780G AHCL system compared to MDI+isCGM therapy in adults with sub-optimally controlled type 1 diabetes participating in the ADAPT study phase (6 months) are maintained during the continuation phase (12 months) and reproduced in the MDI+isCGM control arm after cross over to AHCL. Methods: TS was measured with the Diabetes Treatment Satisfaction Questionnaire status and change (DTSQs/c) and FoH with the Hypoglycemia Fear Survey (HFS). Endpoints were within-arm changes from 6 to 12 months. Results: At 12 months, A1c (7.4%) and TS &amp; FoH scores achieved with AHCL at 6 months were maintained (Fig). In the control arm switching to AHCL, improved A1c (7.5%) was reproduced. Mean DTSQs score increased significantly (21.9 to 29.9, P&amp;lt;0.0001) with significant improvements in perceived frequency of hyper (P&amp;lt;0.001) &amp; hypoglycemia (P=0.0206). Results were consistent for DTSQc except no significant change in perceived frequency of hypo was observed. Median HFS score decreased by 6.5 points (P=0.0306). Conclusion: At 12 months, improved TS &amp; FoH observed in the AHCL arm were sustained, while substantial improvements in TS &amp; reduced FoH were seen in the MDI+isCGM arm after switching to AHCL. Disclosure O.Cohen: Employee; Medtronic. P.Choudhary: Advisory Panel; Medtronic, Novo Nordisk, Dexcom, Inc., MannKind Corporation, Insulet Corporation, Research Support; Abbott Diabetes, Speaker's Bureau; Sanofi, Lilly. M.Evans: Advisory Panel; Zucara Therapeutics, Pila Pharma, Dexcom, Inc., Other Relationship; Novo Nordisk, AstraZeneca, Abbott Diabetes, Speaker's Bureau; Eli Lilly and Company. J.Shin: Employee; Medtronic. R.Re: Employee; Medtronic. J.Castañeda: Employee; Medtronic. L.H.Vorrink - de groot: Employee; Medtronic. A.Ozdemir saltik: Employee; Medtronic. S.De portu: Employee; Medtronic, Stock/Shareholder; Medtronic. Funding Medtronic

691-P: Characteristics of People with Type 1 Diabetes Who Consider Fear of Hypoglycemia a Barrier to Their Diabetes Management

Hypoglycemia is a common side effect of insulin therapy, the constant threat of hypoglycemia symptoms and consequences may lead people with type 1 diabetes (T1D) to develop fear of hypoglycemia (FOH). This analysis aims to explore the characteristics of people who consider FOH as a barrier to managing diabetes. Methods: Self-reported data from an online T1D registry were analyzed to compare participants who consider FOH a barrier to those who do not (a registry-specific yes/no question) using χ2 test for categorical variables (gender, diabetes technology use, and hypoglycemia history) and the Mann-Whitney Test for age, T1D duration, Hypoglycemia Fear Survey (HFS-II), Hypoglycemia Confidence Survey (HCS), and Diabetes Distress Scale (DDS) scores. Results: Among 780 adults, 65% women, aged 44±15 years, had T1D for 25±15 years, 35% reported HbA1c≤ 7%, and 45% perceived FOH as a barrier. The prevalence of FOH as a barrier was higher in women, participants with history of symptomatic nocturnal or level 3 hypoglycemia, higher HbA1c, higher HFS and DDS scores, and lower HCS scores (Table 1). Conclusion: A significant proportion of adults, in particular women and those with a challenging T1D management (high HbA1c, history of hypoglycemia, diabetes distress, and low hypoglycemia confidence), consider FOH to be a barrier in T1D management, thus it needs to be considered as part of clinical follow-up. Disclosure M.K.Talbo: None. C.Leroux: None. L.Hill: None. A.Brazeau: Other Relationship; Dexcom, Inc., Diabète québec, Ordre des diététistes nutritionnistes du Québec, Research Support; Canadian Institutes of Health Research, Fonds de recherche du Québec en Santé.

388-P: The Impact of Routine CGM on Hypoglycemia Rates and Psychological Outcomes in the Hypo-METRICS Study

We aimed to compare weekly rates of sensor detected hypoglycemia (SDH), person reported hypoglycemia (PRH) and psychological outcomes in people with type 1 (T1D) and insulin treated type 2 diabetes (T2D) using routine continuous glucose monitoring (CGM) or capillary blood glucose monitoring (BGM) in the prospective observational Hypo-METRICS study. Participants (T1D/CBG=67, T1D/CGM=210, T2D/CBG=192, T2D/CGM=133, 55% men, median (IQR) age 56 (45-66) years) completed person reported outcomes measures, wore a blinded study CGM and reported PRH in real time on the Hypo-METRICS app for 10 weeks. We used the Wilcoxon rank sum test. Median weekly PRH rates were higher in CGM vs BGM users in both T1D (4.5 (2.4-6.3) vs 2.6 (1-3.9) Z=-5.1, p&amp;lt;0.005) and T2D (1.7 (0.6-2.3) vs 1.0 (0.2-1.2), Z=-5.8 p&amp;lt;0.005). There were no differences in SDH rates at 70 or 54mg/dl for CGM or BGM users with T1D or T2D (Table 1). Diabetes distress (Problem Areas In Diabetes) was higher in CGM vs BGM users with T1D (25 (10-36) vs 19 (5-26), Z=-3.2, p=0.008), but not T2D. There were no significant differences between CGM and BGM users in Hypoglycaemia Fear Survey Behaviour or Worry subscales, depression (PHQ-9) or anxiety (GAD-7) in either group. Despite similar SDH rates, T1D CGM users have higher PRH and diabetes distress scores; this may reflect populations with greater access to CGM. Further research is needed to investigate these findings. Disclosure N.Zaremba: None. M.Evans: Advisory Panel; Zucara Therapeutics, Pila Pharma, Dexcom, Inc., Other Relationship; Novo Nordisk, AstraZeneca, Abbott Diabetes, Speaker's Bureau; Eli Lilly and Company. E.Renard: Consultant; Abbott Diabetes, Dexcom, Inc., AstraZeneca, Boehringer-Ingelheim, Eli Lilly and Company, Insulet Corporation, MannKind Corporation, Novo Nordisk, Sanofi, Roche Diabetes Care. S.R.Heller: Advisory Panel; Zealand Pharma A/S, Zucara Therapeutics, Other Relationship; Eli Lilly and Company, Research Support; Dexcom, Inc., Speaker's Bureau; Novo Nordisk, Medtronic. J.Speight: Research Support; Sanofi, Medtronic, Abbott Diabetes, Lilly, Novo Nordisk A/S, Speaker's Bureau; Sanofi. S.A.Amiel: Advisory Panel; Medtronic, Other Relationship; Sanofi, Novo Nordisk. P.Choudhary: Advisory Panel; Medtronic, Novo Nordisk, Dexcom, Inc., MannKind Corporation, Insulet Corporation, Research Support; Abbott Diabetes, Speaker's Bureau; Sanofi, Lilly. P.Divilly: None. G.Martine-edith: Other Relationship; Novo Nordisk A/S. Z.Mahmoudi: Employee; Novo Nordisk. U.Soeholm: Employee; Novo Nordisk A/S. B.E.De galan: Research Support; Novo Nordisk. U.Pedersen-bjergaard: Advisory Panel; Novo Nordisk A/S, Sanofi, Vertex Pharmaceuticals Incorporated. R.J.Mccrimmon: Advisory Panel; Sanofi, Speaker's Bureau; Novo Nordisk A/S. J.K.Mader: Advisory Panel; Novo Nordisk A/S, Abbott Diabetes, Roche Diabetes Care, Eli Lilly and Company, Sanofi, Medtronic, Becton, Dickinson and Company, Pharmasense, embecta, Research Support; A. Menarini Diagnostics, Abbott Diabetes, Roche Diabetes Care, Dexcom, Inc., Profusa, Inc., Speaker's Bureau; Novo Nordisk A/S, A. Menarini Diagnostics, Abbott Diabetes, Roche Diabetes Care, Eli Lilly and Company, Sanofi, Boehringer Ingelheim Inc., Becton, Dickinson and Company, Ypsomed AG, Viatris Inc., Servier Laboratories, Medtrust, Stock/Shareholder; Decide Clinical Software GmbH. Funding Innovative Medicines Initiative 2 Joint Undertaking (777460)

Evaluation of Change in Quality of Life, Dental Fear and Dental Anxiety in Young Children Following Full-mouth Dental Rehabilitation under General Anesthesia for Early Childhood Caries.

To evaluate the change in quality of life, dental fear, and dental anxiety in young children following full-mouth dental rehabilitation under general anesthesia for early childhood caries. About 200 children who were diagnosed with early childhood caries requiring full-mouth rehabilitation under general anesthesia were recruited after obtaining parental consent. Oral health-related quality of life (OHRQoL) was measured using the Early Childhood Oral Health Impact Scale (ECOHIS). Dental fear was evaluated using Children's Fear Survey Schedule-Dental Subscale and dental anxiety was evaluated using the Facial Image Scale. Scores were taken on the day of intervention, and after 14 days when the child reported for posttreatment follow-up. All 200 participants returned for a follow-up visit after 2 weeks. The child impact section was reduced from 15.7 ± 4.1 to 7.7 ± 1.9 after treatment. The family impact section was reduced from 9.6 ± 2.7 to 3.5 ± 2.6 after treatment. A statistically significant difference was seen in both sections when pre-and posttreatment values were compared (p < 0.001). The total ECOHIS showed statistically significant improvement as the pretreatment score of 21.6 ± 9.5 reduced to 11.2 ± 4.2 showing 51.9% improvement in OHRQoL after full-mouth rehabilitation under general anesthesia was done (p < 0.001). Dental fear and anxiety among the participants showed a statistically significant reduction after treatment was done and most participants were found to be less fearful of doctors, dentists, and injections after treatment. Full-mouth rehabilitation was found to be a reliable treatment modality to improve the OHRQoL of children suffering from early childhood caries. Significant improvement was seen in the OHRQoL within 2 weeks after treatment and most participants were found to be less anxious and fearful toward dentists and dental treatment. Comprehensive dental rehabilitation under general anesthesia has been proven to be an effective treatment modality for early childhood caries and a productive treatment technique to reduce dental fear and anxiety.

Exploring Preschoolers' Emotions in Pediatric Dentistry.

Emotion is a feeling that someone can feel. Emotions are generally shown through behavior or facial expressions. Emotions are essential for dental treatment because there is a relation between the emotions felt by children and the success of the dental treatment that the dentist will give. This study aimed to describe variables of emotions about dental treatment. Descriptive analysis using a convenience nonrandom sampling technique was conducted on 58 preschool children aged 3 to 6 years old who came for dental treatment at the Bandung Dental Center in Bandung, Indonesia. The instrument used to ask children how they feel about dental care is a 7-item questionnaire derived from the children's fear survey scale-dental subscale. Meanwhile, the media used by children to respond was a card with facial expressions from the Facial Expression Emotion Scale. The results showed that only participants aged 4 responded with one type of emotion (happy), while the other age groups gave various emotional responses. Fear emotion began to appear in the age group of 5 and 6 years and only in girls, while emotions of anger also appeared in girls and only at the age of 5. In this study, the emotions that children choose about dental care at the Bandung Dental Center clinic are happy emotions. The emotions of fear and sadness were chosen more by girl participants, while none of the boy participants chose the emotion of fear. This sad and fearful response is associated with invasive dental treatment. Anger was chosen as a child's response dominantly because of the parents' invitation to the dentist.

Association of dental hypersensitivity and anxiety in children with molar-incisor hypomineralisation (MIH).

The objective of this study was to investigate whether dental hypersensitivity and dental fear were linked to the presence and severity of MIH. For this cross-sectional study, 1830 students between the ages of 6 and 12years were recruited from four randomly selected schools. The Children's Fear Survey Schedule-Dental Subscale questionnaire was used to assess dental anxiety and fear. The children's self-reported dental hypersensitivity resulting from MIH was evaluated using the Wong-Baker Facial Scale and the Visual Analog Scale (VAS). MIH was correlated with tooth hypersensitivity, particularly in severe cases. Dental fear was present in 17.4% of the children with MIH, but it was not associated with dental hypersensitivity, gender, or age. No association was found between dental fear and dental hypersensitivity in children with MIH.