Hypoglycemia Fear Survey Research Articles

Association between sleep disturbances, fear of hypoglycemia and psychological well-being in adults with type 1 diabetes mellitus, data from cross-sectional VARDIA study

AimTo assess the relationship between sleep quality, fear of hypoglycemia, glycemic variability and psychological well-being in type 1 diabetes mellitus. MethodsOur data were provided by the VARDIA Study, a multicentric cross-sectional study conducted between June and December 2015. Sleep characteristics were assessed by the Pittsburgh Sleep Quality Index (PSQI). Fear of hypoglycemia and psychological well-being were measured with the Hypoglycemia Fear Survey version II (HFS-II) and the Hospital Anxiety and Depression Scale (HADS), respectively. Glycemic variability (GV) was determined using the CV of three 7-point self-monitoring blood glucose profiles and the mean amplitude of glycemic excursion (MAGE). Results315 patients were eligible for PSQI questionnaire analysis: 54% women, mean age 47 ± 15, mean diabetes duration of 24 ± 13 years, HbA1c of 7.6 ± 0.9% (60 ± 7,5mmol/mol). Average PSQI score was 6.0 ± 3.3 and 59.8% of the patients had a PSQI score > 5. HFS-II score and HADS were significantly higher among “poor” sleepers (p < 0.0001) and PSQI score was positively associated with HADS (β = 0.22; 95% CI = 0.08;0.35). GV evaluated by CV or MAGE did not differ between “poor” and “good” sleepers (p = 0.28 and 0.54, respectively). ConclusionsAdult patients with type 1 diabetes have sleep disturbances which correlate with psychological well-being. This study suggests that psychological management can be a target to improve sleep quality in adults with type 1 diabetes mellitus.

High frequency of hypoglycaemia in patients with type 1 diabetes mellitus attending a tertiary diabetes clinic in Durban, South Africa

AimThe study aimed to assess the prevalence of hypoglycaemia in subjects with type 1 diabetes (T1D) attending a public health tertiary diabetes clinic in Durban, South Africa. MethodsPatients with T1D were enrolled at the time of clinic attendance. Data on hypoglycaemia over the previous 12 weeks were obtained from glucose meter downloads as well as diary records. Each patient completed the Hypoglycaemia Fear Survey questionnaire as well as an in-house questionnaire on hypoglycaemic episodes in the previous 12 months. ResultsA total of 151 subjects (58% female, 54% black African) were enrolled. “Any” hypoglycaemia occurred in 144 (95.4%) in the 12 months prior to clinic attendance. Of these, “severe” hypoglycaemia occurred in 107 (74.3%) and 22 (20.6%) had five or more severe episodes. The most frequent behavioural change in response to hypoglycaemia was insulin dose self-adjustment and the commonest worry was the possibility of becoming emotionally upset during hypoglycaemia. ConclusionsIn a tertiary diabetes clinic in Durban, South Africa, there was a high frequency of hypoglycaemia in patients with T1D and in the majority, at least one severe episode occurred in the 12 months prior to clinic attendance. The results indicate a need for further study and strategies to reduce the frequency and severity of hypoglycaemia.

1349-P: Sociodemographic and Clinical Factors Associate with Parental Fear of Hypoglycemia: Italian Nationwide Cross-Sectional Survey

Aim of this study was to evaluate the association of socio-demographic and clinical factors, including technologies used for diabetes management, and parental fear of hypoglycaemia (FOH) in parents of children (&amp;lt;18y) with T1D. A cross-sectional, nationwide electronic survey, supported by the Italian Society of Paediatric Endocrinology and Family Associations of children with diabetes, was conducted during September-November 2018. The Hypoglycaemia Fear Survey for Parents (HFS-P), a 25-item questionnaire, was used to assess FOH. Quintile regression analysis was performed to estimate factors associated to FOH. Out of 1450 questionnaires, 1106 (873 mothers) reported a complete HFS-P in both the worry and behavior subscales. Children median age was 11 y (IQR: 8-14), median diabetes duration 6 y (IQR: 3-10); median HbA1c 7.2% (IQR: 6.7-7.8). Glucose Sensor (including CGM and FGM) was used in 79% of patients and insulin pump in 45%. Median HFS-P worry score was 36 (IQR: 29-46), behavior score 29 (IQR: 24-33). Parental FOH was associated with parental modifiable and non-modifiable factors (Table 1). The use of insulin pump does not seem to impact worries and behaviors, while glucose sensor do influence parental behaviors. As the use of diabetes-advanced technologies is today increasingly widespread, the impact on parental FOH requires more analyses. Disclosure V. Cherubini: None. D. Pjetraj: None. R. Bonfanti: Advisory Panel; Self; Abbott, Lilly Diabetes, Medtronic, Novo Nordisk A/S, Roche Diabetes Care, Sanofi. M. Marino: None. A. Iannilli: None. F. Carle: None. R. Gesuita: None.

121-LB: Early Independent View of Quality of Life in Patients with Type 1 Diabetes Using Hybrid Closed-Loop Insulin Delivery System in Real-World Clinical Practice

The MiniMed™ 670G (670 HCL) is the first FDA-approved hybrid closed-loop insulin delivery system device for patients with type 1 diabetes (T1D). This study aimed at evaluating clinical and patient-reported outcomes (PROs) in patients with T1D utilizing this technology. We evaluated 54 patients with T1D using the 670 HCL in real-world clinical practice (mean age 47.9±13.2 years, 57% females, BMI 28.8±5.9 kg/m2). Data were collected at baseline and after 3 months. Measures of PROs included: Pittsburgh Sleep Quality Index (PSQI), Hypoglycemia Fear Survey Worry (HFS_W) scale, and 36-Item Short-Form Health Survey (SF-36). We also measured changes in A1C after 3 months and % of time in auto-mode (% TIAM) over the two weeks preceding the 3-month visit. Regression analyses were done between these 2 parameters and PROs. Other glycemic and quality-of-life parameters were collected at 3 months and at one year but are not included in this early report. At 3 months, A1C decreased by 0.4±0.12% from baseline (p=0.0027). Average % TIAM was 63.9±33.1%. Among all surveyed PROs, only fear of hypoglycemia and social functioning improved compared to baseline (p&amp;lt;0.05 for both). There was no association between changes in PROs and reduction in A1C or % TIAM. In conclusion, patients with T1D using the MiniMed™ 670G hybrid closed-loop system in real-world clinical practice are able to improve their A1C, fear of hypoglycemia, and social functioning but not other PROs included in the SF-36 after 3 months of use. The limited improvement in some of the PROs is not associated with the reduction in A1C or % TIAM. Disclosure A.H. Eldib: None. E. Toschi: Advisory Panel; Self; Lexicon Pharmaceuticals, Inc. N. Mahmoud: None. M. Tasabehji: None. S. Ashrafzadeh: None. S. Tomah: Stock/Shareholder; Self; Amarin Corporation. S.E. Dhaver: None. A. Atakov-Castillo: None. A.E. Abdul-Ghani: None. K. Farkouh: None. R. Trevino: None. O. Hamdy: Advisory Panel; Self; AstraZeneca, Sanofi-Aventis. Consultant; Self; Abbott, Merck &amp; Co., Inc. Research Support; Self; National Dairy Council. Stock/Shareholder; Self; Healthimation, LLC.

891-P: Hypoglycemia Prevention Behaviors Prevent Moderate Hypoglycemic Events: The REPLACE-BG Trial

Background: Continuous glucose monitoring (CGM) provides real-time glucose levels and alarms for hypoglycemia. We analyze CGM data from the REPLACE-BG trial, which had 6 months of CGM data on people with well controlled type 1 diabetes (T1D), to characterize hypoglycemic events and evaluate their association with hypoglycemia-related behaviors. Methods: We conducted a psychometric analysis of the Hypoglycemia Fear Survey- Behavior scale to identify unique hypoglycemia behavior constructs. We identified and categorized hypoglycemic events in CGM data as mild (min glucose &amp;lt;70 mg/dL) and moderate (min glucose &amp;lt;50 mg/dL) and used ANOVA to evaluate differences in the frequency and duration of events by high and low score categories of hypoglycemia behavior constructs. We used multivariate linear regression to evaluate the association between hypoglycemia behavior constructs and 1) duration of moderate hypoglycemic events and 2) proportion of moderate hypoglycemic events. Results: We separated the HFS-B into three scales: hypoglycemia avoidance, reaction, and prevention. In low vs. high hypoglycemia prevention score categories, the duration of moderate hypoglycemic events was significantly longer (73 vs. 66 minutes, p&amp;lt;0.05) and proportion of moderate hypoglycemic events was higher (22.4 vs. 20.1, p&amp;lt;0.1). In multivariate models that included all three hypoglycemia behavior scales, hypoglycemia prevention behavior was significantly, inversely associated with 1) duration of moderate hypoglycemic events (β= -6.9, SE= 2.2, p&amp;lt; 0.01) and 2) proportion of moderate hypoglycemic events (β= -2.2, SE= 0.7, p-value &amp;lt; 0.01). Conclusion: Hypoglycemia is common in T1Ds. The increased likelihood of engaging in hypoglycemia prevention behaviors reduces the frequency and duration of dangerous moderate hypoglycemic events. Analyzing CGM data in its continuous form reveals the frequency and characteristics of individual hypoglycemic events. Disclosure M.A. Crawford: Employee; Self; Dexcom, Inc. M.M. White: None. D.R. Strong: None. J.P. Pierce: None.

Use of continuous glucose monitoring for sport in type 1 diabetes

BackgroundThe benefits of exercise for patients with type 1 diabetes (T1D) are difficult to balance with associated glycaemic excursions. The aim of this cohort study was to show that continuous...

Acceptance and commitment therapy (ACT) for adult type 1 diabetes management: study protocol for a randomised controlled trial

IntroductionIntegrating diabetes self-management into daily life involves a range of complex challenges for affected individuals. Environmental, social, behavioural and emotional psychological factors influence the lives of those with diabetes. The...

The Use of Continuous Glucose Monitoring With Remote Monitoring Improves Psychosocial Measures in Parents of Children With Type 1 Diabetes: A Randomized Crossover Trial.

This study aimed to explore the effect of continuous glucose monitors with remote monitoring on psychosocial outcomes in parents of children with type 1 diabetes. Children with type 1 diabetes, aged 2-12 years, along with their parents, were studied in a randomized crossover study. They participated in two 3-month periods using conventional blood glucose monitoring (control) or the Dexcom G5 Mobile continuous glucose monitoring (CGM) system with remote monitoring (intervention). The primary outcome was parental fear of hypoglycemia score assessed by the Hypoglycemia Fear Survey. Parental Hypoglycemia Fear Survey scores were lower while the child was using CGM with remote monitoring (P < 0.001). Furthermore, parental health-related quality of life and family functioning, stress, anxiety, and sleep measures also improved significantly after intervention. CGM with remote monitoring was found to improve multiple measures of quality of life, reduce family stress, and improve parental sleep.

Improved diabetes medication convenience and satisfaction in persons with type 2 diabetes after switching to insulin glargine 300 U/mL: results of the observational OPTIN-D study

ObjectiveInsulin glargine 300 (Gla-300) provides less hypoglycemia risk and more flexibility in injection time. The extent to which these effects translate into improved patient-reported outcomes (PROs) is unknown, and is...

Correlates of Hypoglycemia among Youth with Type 1 Diabetes (T1D) and Suboptimal Glycemic Control

Hypoglycemia is a major challenge of T1D. We examined the prevalence and correlates of hypoglycemia assessed by 7-day blinded continuous glucose monitoring at baseline among 233 youth with hemoglobin A1c (HbA1c) of 8-13% per inclusion criteria in the Flexible Lifestyles Empowering Change trial. The sample was 76.1% non-Hispanic white and 49.8% female with mean age 14.9±1.1 years and mean T1D duration 6.4±3.7 years. Mean HbA1c was 9.6±1.2%. Over 7-days, 85.4% of youth experienced hypoglycemia (i.e., time ≤70 mg/dL and &amp;gt;54 mg/dL; an average of 32.5±37.3 min/day). 62.7% of youth experienced clinically serious hypoglycemia (i.e., time ≤54 mg/dL; an average of 24.5±40.5 min/day). Duration of hypoglycemia was inversely associated with HbA1c (Figure). In logistic regression modeling, sex, race/ethnicity, T1D duration, body mass index z-score (BMIz), fear of hypoglycemia (from the Hypoglycemia Fear Survey) and diabetes adherence (from the Diabetes Self-Management Profile-Self Report) were not associated with hypoglycemia. Youth with higher HbA1c were less likely to experience hypoglycemia (for a 1% higher HbA1c, odds ratio (OR) for clinical hypoglycemia: 0.52, (95% CI 0.39, 0.69); OR for clinically serious hypoglycemia: 0.58 (95% CI 0.43, 0.77)). The data suggest that hypoglycemia is common among youth with elevated HbA1c and and guidance to limit hypoglycemia should be part of care in these patients. Disclosure A.R. Kahkoska: None. J. Crandell: None. K.A. Driscoll: None. M.R. Kosorok: None. D.M. Maahs: Advisory Panel; Self; Insulet Corporation. Consultant; Self; Abbott. Research Support; Self; Medtronic, Bigfoot Biomedical, Dexcom, Inc., Insulet Corporation, Roche Diabetes Care Health and Digital Solutions. E.J. Mayer-Davis: None.

Poor Adherence in Adolescents with Type 1 Diabetes Associated with Distress, Fear of Hypoglycemia, and Executive Functioning

Introduction: T1D poses unique challenges to adherence-related behavior due to complex treatment regimens. This study aimed to determine prevalence rates of adherence in adolescents on multiple daily injections (MDI) or subcutaneous insulin infusion (CSII). Additional aims included determination of whether adherence correlated to HbA1c and whether psychological factors predicted adherence. Methods: Self-monitoring of blood glucose (SMBG) and insulin delivery data were downloaded for the previous 30 days. Distress was measured using the Problem Areas in Diabetes-Teen Version, the Blood Glucose Monitoring Communication Questionnaire, and the Barriers to Diabetes Adherence survey. The Hypoglycemia Fear Survey and Behavior Rating of Executive Function were administered. Bivariate correlations and hierarchical regressions were used to determine how adherence related to HbA1c and the predictive value of psychological factors. Continuous glucose monitor (CGM) use was considered as a covariate. Results: Adolescents (N=81; 41 on MDI and 40 on CSII; 32 on CGM) aged 11 to 17 years completed the study. The mean HbA1c was 8.74% (SD=1.74%). Daily, &amp;lt;7% of participants engaged in SMBG ≥4 times; &amp;lt;7% engaged in carbohydrate entry ≥3 times, and &amp;lt;20% engaged in bolus delivery ≥3 times. Hyperglycemia readings were followed by a correction bolus in 58% of cases. HbA1c was negatively correlated with several adherence domains: frequency of SMBG (r=-0.465, p&amp;lt;.01), carbohydrate entry (r=-0.511, p&amp;lt;.01), and bolus insulin delivery (r=-0.522, p&amp;lt;.01). Distress and fear of hypoglycemia predicted adherence to correction bolusing for hyperglycemia (R2=.237, p&amp;lt;.05) in a model with child age, gender, and executive functioning. Conclusions: Findings suggest adolescents do not adequately adhere to treatment for T1D. The use of diabetes treatment technology is helpful to measure specific domains of adherence and clarify relationships with psychological factors. Disclosure S.C. Westen: None. J. Warnick: None. M. Entessari: None. A. Albanese-O'Neill: None. D. Schatz: None. M.J. Haller: None. D.M. Janicke: None.

Impact of Aging on Risk of Hypoglycemia in Patients with Type 1 Diabetes

Background: As T1D patients routinely reach older age, more information is needed to understand the impact of aging on the risk of hypoglycemia and its interaction with other age-related issues. Methods: We evaluated 2 groups of patients with T1D: older (age &amp;gt;65 years) and younger (age 18-35 years). All patients were subjected to either blinded CGM for 2 weeks or assessment of personal CGM. A hypoglycemia fear survey (HFS II), and a Clarke hypoglycemia unawareness survey were completed. Patients were also assessed for cognitive function by the Montreal Cognitive Assessment (MoCA). Glycemic control was measured by A1C. Results: We evaluated 56 patients with T1D; 23 in the older and 33 in the younger group. The average age was 70 vs. 28 years; diabetes duration 36 vs. 14 years; A1C 8.0% vs. 7.9%, respectively. Clinically significant hypoglycemia (glucose ?54 mg/dL for &amp;gt; 15 mins/episode) occurred equally in 91% of older (mean 28 minutes/day) and 88% of younger (mean 23 mins/day) patients. Older patients reported hypoglycemia unawareness more (39% vs. 30%), with similar scores on HSF II (34 vs. 33). However, 61% of older patients had cognitive impairment (MoCA score &amp;lt;26) compared to 12% in younger adults. There was a higher comorbidity burden in older patients (average number of comorbidities 4 vs. 1), with a higher number of daily medications (10 vs. 4). Conclusion: The risk of hypoglycemia is similar in older and younger patients with T1D. However, higher incidence of comorbidities including cognitive dysfunction and polypharmacy may increase the risk of poor outcomes due to hypoglycemia. Disclosure M. Munshi: Consultant; Self; Sanofi. C. Slyne: None. A. Atakov-Castillo: None. J. Greenberg: None. T. Greaves: None. S.P. Carl: None. E. Toschi: None.

Risk of Hypoglycemia in Aging Population with Insulin-Requiring Diabetes

Background: The impact of aging on insulin-dependent diabetes is not well studied. Methods: We evaluated insulin-dependent older adults (age &amp;gt;65 years) with type 1(T1D) and type 2 diabetes (T2D). All patients completed questionnaires for demographics, hypoglycemia fear survey (HFS II), hypoglycemia unawareness (Clarke’s method) and assessment of comorbidities. A1c was measured, and blinded CGM was performed over 2-week period. Results: We evaluated 32 insulin-dependent older adults: 23 had T1D (age 70±4 years, A1C 8%) and 9 had T2D (age 80±9 years, A1C 8.9%). All with T1D were either on insulin pump or on ≥4 insulin injections/day compared to 55% of patients with T2D. Clinically significant hypoglycemia (glucose &amp;lt; 55 mg/dl for ≥ 20 mins/episode) was observed in 91% of patients with T1D (21 of 23), compared with 22% with T2D (2 of 9). Nocturnal hypoglycemic episodes (10 pm-6 am) were observed in 15 out of 23 (65%) T1D patients, compared to 1 out of 9 (11%) with T2D. Older adults with T1D had greater fear of hypoglycemia as shown by HFS II score of 34 compared to 15 in T2D. However, hypoglycemia unawareness was similar in the two groups (9 of 23 (39%) with T1D, and 3 of 9 (33%) with T2D. Age-associated comorbidities in T1D and T2D older adults included Cognitive impairment (68% vs. 100%), depression (27% vs. 43%), recent falls within 6-months (24% vs. 43%), vision impairment (27% vs. 43%), and hearing impairment (36% vs. 50%) respectively. Conclusions: Insulin-dependent older adults with T1D have a higher risk of total and nocturnal hypoglycemia compared to older adults with T2D. Associated multiple age-related comorbidities put them at higher risk of poor outcomes. Disclosure M. Munshi: Consultant; Self; Sanofi. C. Slyne: None. A. Atakov-Castillo: None. J. Greenberg: None. T. Greaves: None. S.P. Carl: None. E. Toschi: None.

Clinic-Wide Screening of Fear of Hypoglycemia in Mothers and Fathers of Children with Type 1 Diabetes

Background: The American Diabetes Association (ADA) recommends anxiety screening in individuals with type 1 diabetes (T1D); however, screening in parents is not addressed. This study describes fear of hypoglycemia (FOH) in parents who were screened as part of their children’s routine T1D clinic visit. Methods: Mothers (n=234) and fathers (n=79) completed the Hypoglycemia Fear Survey - Parent comprising 3 subscales: Maintaining High Blood Glucose (BG), Worry/Helplessness About Low BG, and Worry About Negative Social Consequences. Scores of ≥7, ≥24, and ≥9, respectively, were used as clinical cutoffs. Higher scores indicate greater fear/worry about hypoglycemia. Results: Child characteristics were: 53% female; mean age = 13.9±2.2 years; mean A1C = 9.3±2.2%, mean T1D duration = 5.1±4.1 years; 58% CSII. Percentage of mothers and fathers exceeding the clinical cutoffs were: 18%, 14% on Maintaining High BG; 15%, 3% Worry/Helplessness About Low BGs; and 14%, 1% Worry About Negative Social Consequences. Compared to fathers, mothers reported significantly more helplessness about low BGs (t(173.6)=3.24, p=0.001), but not more worry about negative social consequences (t(223.4)=1.42, p=0.16), or engaging in behaviors to maintain high BGs (t(290)=0.68, p=0.50). Parents of older children (≥13 years) worried equally about hypoglycemia (p&amp;gt;0.05), but reported engaging in fewer behaviors to maintain high BGs than parents of younger children (10-12 years) (t(307)=3.27, p&amp;lt;0.001). Conclusions: FOH is common in both mothers and fathers. Mothers reported more feelings of helplessness than fathers, whereas both mothers and fathers of younger children reported engaging in more behaviors to maintain high BGs than parents of older children. These results support the need to screen parents - not just patients with T1D - for FOH and provide intervention when indicated. Consideration should be given to including recommendations about FOH screening parents in the ADA Medical Standards of Care. Disclosure S. Majidi: None. H. O'Donnell: None. K. Benson: None. K.A. Driscoll: None.

The influence of fear of hypoglycemia on the treatment compliance of diabetes patients

Objective To investigate the influence of fear of hypoglycemia on the compliance of diabetes patients. Methods A total of 201 diabetes inpatients with hypoglycemia in four first-class hospital of grade three in Ji'nan were selected by convenience sampling method and investigated by General Information Questionnaire, Chinese version of Hypoglycemia Fear Survey Ⅱ-Worry Scale and Diabetes Treatment Compliance Scale. And carrid on the correlation analysis and the multiple linear regression analysis. Results The scores of fear of hypoglycemia was 3-33 points, the median score was 12 points (interquartile range, 10-15 points). The score of treatment compliance was 23-55 (35.90±5.84) points. Spearman correlation analysis showed that fear of hypoglycemia score were negative correlated with treatment compliance score, drug, diet, exercise dimensions (r=-0.467- -0.288), and it was positively correlated with self monitoring dimension(r=0.259), the difference was statistically significant (P<0.01), it was not associated with periodic inspection dimension. Multiple linear regression analysis showed that the economic income, occupation, whether to participate in health education of diabetes mellitus, glycosylated hemoglobin, fear of hypoglycemia were the influence factors of treatment compliance. Conclusions Diabetes patients’ fear of hypoglycemia can influence treatment compliance. medical staff should pay attention to and take effective measures to reduce their fear of hypoglycemia and improve treatment compliance. Key words: Diabetes mellitus; Fear of hypoglycemia; Treatment compliance; Influencing factors

Spanish translation, adaptation and validation of the Hypoglycemia Fear Survey in adults with type 1 diabetes in the Community of Madrid

Background and objectiveThe negative impact of hypoglycemia on patients with type 1 diabetes mellitus (T1DM) may lead to development of fear of hypoglycemia. In this study, the original Hypoglycemia Fear Survey (HFS) questionnaire was translated into Spanish, adapted and validated, and variables associated to fear of hypoglycemia in T1DM were analyzed. Materials and methodsThe HFS was translated and adapted to Spanish using the forward-backward translation method. The resulting questionnaire, EsHFS, was administrated to a population with T1DM. The following parameters of the questionnaire were analyzed: feasibility, reliability (Cronbach's alpha), content validity (correlating EsHFS and EsDQOL [Diabetes Quality of Life] questionnaire), and stability (by means of test–retest correlation). ResultsThe EsHFS questionnaire consists of 24 items and three subscales including: subscale 1 on worry; subscale 2 on hypoglycemia-avoidant behavior, and subscale 3 on hyperglycemia-influenced behavior. Study population: 163 subjects, with a mean aged (SD) of 36 (10.5) years, 24% on continuous subcutaneous insulin infusion. Of these, 99.8% completed the EsHFS questionnaire in less than 10min. Cronbach's alpha for global EsHFS was 0.92. EsHFS and its subscales correlated with EsDQOL. Test–retest correlation (Pearson) was r=0.92. Age, female sex, lower educational level, living alone, frequency of daily self-monitoring and non-severe hypoglycemia, and history of severe and/or asymptomatic hypoglycemia were independently associated to the result of EsHFS. ConclusionsThe Spanish version of the HFS, EsHFS, has good psychometric properties and may be a useful tool to assess fear of hypoglycemia in Spanish-speaking patients with T1DM.

Traducción al español, adaptación y validación del Cuestionario de miedo a la hipoglucemia en adultos con diabetes tipo 1 de la Comunidad de Madrid

Background and objectiveThe negative impact of hypoglycemia on patients with type 1 diabetes mellitus (T1DM) may lead to development of fear of hypoglycemia. In this study, the original Hypoglycemia Fear Survey (HFS) questionnaire was translated into Spanish, adapted and validated, and variables associated to fear of hypoglycemia in T1DM were analyzed. Material and methodsThe HFS was translated and adapted to Spanish using the forward-backward translation method. The resulting questionnaire, EsHFS, was administrated to a population with T1DM. The following parameters of the questionnaire were analyzed: feasibility, reliability (Cronbach's alpha), content validity (correlating EsHFS and EsDQOL [Diabetes Quality of Life] questionnaire), and stability (by means of test-retest correlation). ResultsThe EsHFS questionnaire consists of 24 items and three subscales including: subscale 1 on worry; subscale 2 on hypoglycemia-avoidant behavior, and subscale 3 on hyperglycemia-influenced behavior. Study population: 163 subjects, with a mean aged (SD) of 36 (10.5) years, 24% on continuous subcutaneous insulin infusion. Of these, 99.8% completed the EsHFS questionnaire in less than 10minutes. Cronbach's alpha for global EsHFS was 0.92. EsHFS and its subscales correlated with EsDQOL. Test-retest correlation (Pearson) was r=0.92. Age, female sex, lower educational level, living alone, frequency of daily self-monitoring and non-severe hypoglycemia, and history of severe and/or asymptomatic hypoglycemia were independently associated to the result of EsHFS. ConclusionsThe Spanish version of the HFS, EsHFS, has good psychometric properties and may be a useful tool to assess fear of hypoglycemia in Spanish-speaking patients with T1DM.

Mindfulness and fear of hypoglycaemia in parents of children with Type 1 diabetes: results from Diabetes MILES Youth - The Netherlands.

AimsTo identify the sociodemographic and clinical correlates of fear of hypoglycaemia among parents of children (aged 4–18 years) with Type 1 diabetes and to examine the relationships between parental fear of hypoglycaemia, mindfulness and mindful parenting.MethodsSociodemographic, self‐reported clinical and psychological data were extracted from the cross‐sectional Diabetes MILES Youth – The Netherlands dataset. Questionnaires included the Hypoglycaemia Fear Survey – Parent Worry (parental fear of hypoglycaemia), the Freiburg Mindfulness Inventory – Short version (mindfulness) and the Interpersonal Mindfulness in Parenting Scale (mindful parenting).ResultsA total of 421 parents (359 mothers) participated. Hierarchical linear regression analyses showed that greater parental fear of hypoglycaemia was related to younger parental age, low educational level, non‐Dutch nationality, more frequent blood glucose monitoring, and less general mindfulness. Adding mindful parenting to the model negated the previous contribution of general mindfulness. In this model, lower mindful parenting was related to greater parental fear of hypoglycaemia. In particular, parents with an increased ability to be less judgemental of themselves as parents and less reactive to emotions within parenting interactions reported less fear of hypoglycaemia. In total, 21% of the variance in parental fear of hypoglycaemia was explained.ConclusionParental fear of hypoglycaemia was associated largely with parental characteristics, including non‐modifiable sociodemographics (i.e. age, education, nationality) and modifiable psychological factors (i.e. mindful parenting). These findings suggest that it is important to further explore mindfulness‐based interventions for parents to reduce fear of hypoglycaemia next to interventions to reduce hypoglycaemia.

A longitudinal study of fear of hypoglycaemia in adults with type 1 diabetes.

SummaryAimsTo investigate fear of hypoglycaemia (FoH) longitudinally in a cross‐sectional study of adult patients with type 1 diabetes. Specifically, we investigated two subgroups of patients who over 4 years either showed a substantial increase or decrease in level of FoH to identify factors associated with changes in FoH.MethodsThe Swedish version of the Hypoglycaemia Fear Survey (HFS) along with a questionnaire to assess hypoglycaemia history was sent by mail to 764 patients in 2010. The responders in 2010 (n = 469) received another set of the same two questionnaires in 2014. HbA1c, insulin regimen, weight and creatinine from 2010 and 2014 were obtained from medical records. Those with an absolute difference in HFS scores ≥ 75th percentile were included in the subgroup analyses. Statistical analyses included one‐sample t tests, chi‐square and McNemar's test.ResultsThe absolute difference in the HFS total score (n = 347) between 2010 and 2014 was m = ±7.6, SD ± 6. In the increased FoH group, more patients reported a high level of moderate hypoglycaemic episodes as well as impaired awareness of hypoglycaemia in 2014 compared with the decreased FoH group. There were more subjects in the increased FoH group with insulin pumps in 2014 and in 2010. In the decreased FoH group, more patients had a high frequency of daily self‐monitoring of blood glucose (SMBG) in 2010 and in 2014.ConclusionsFear of hypoglycaemia is stable across time for most patients. Changes in fear level are associated with changes in hypoglycaemia frequency. Thus, asking patients about changes in hypoglycaemia experiences is of great importance.

Fear of hypoglycemia in patients with type 2 diabetes: The role of interoceptive accuracy and prior episodes of hypoglycemia

ObjectiveFear of hypoglycemia (FoH) is a limiting factor for diabetes self-management and can have detrimental effects on quality of life. However, relatively little is known about its underlying mechanisms. In line with findings on patients with anxiety disorders, we hypothesized that interoceptive accuracy (IA) might be positively linked to FoH in patients with type 2 diabetes (T2DM). Methods133 patients with T2DM were screened according to the extreme quartiles of the Hypoglycemia Fear Survey worry subscale (HFS-W). Overall, 66 participants (HFS-W<4; HFS-W>17) were included in the present study. Participants completed questionnaires on sociodemographic and diabetes-related measures. Accuracy of heartbeat perception was assessed using the mental tracking task. ResultsContrary to expectations, IA did not differ significantly between patients with low and high FoH. A linear regression analysis demonstrated that the experience of mild hypoglycemia (β=0.32, p≤0.01) and its interaction with IA (β=−0.26, p=0.040) were significant predictors of FoH, indicating that low IA and a history of experiencing mild hypoglycemia are positively associated with FoH. ConclusionOur findings suggest a positive association of low IA in combination with prior episodes of hypoglycemia and FoH in patients with T2DM. The results are in line with recent findings on IA in patients with chronic somatic symptom distress more generally and contribute to our understanding of the relations between interoception, body related fears, and physical symptom perception.