Diabetes distress and fear of hypoglycaemia: what are the psychological benefits of insulin pump therapy?

Abstract

Living with type 1 diabetes imposes a considerable burden on the individual to continuously self‐manage their condition. As part of an ongoing audit, the psychological outcomes of insulin pump therapy were evaluated over a three‐year period. Adult patients completed self‐report questionnaires at initiation and after 12 months of pump therapy. Diabetes emotional distress was assessed using the Problem Areas in Diabetes Scale (PAID) and cognitive and behavioural aspects of fear of hypoglycaemia using the Hypoglycaemia Fear Survey (HFS‐W, HFS‐B). HbA1c and demographic data were obtained from the clinical record. Data were collected from 190 adults, age mean (SD) years 39.6(13.9), duration of diabetes 21.0(14.1). Outcomes improved significantly from baseline to 12 months for all variables (mean [SD]): HbA1c mmol/mol 73.4(14.9), 64.6(13.1), p<0.000; PAID 23.0(14.4), 16.9(13.3), p<0.000; HFS‐W 24.1(16.3), 15.0(12.9), p<0.000; HFS‐B 19.1(9.7), 13.4(8.1), p<0.000. Paired data analysis did not indicate an association between HbA1c reduction and reduced PAID and HFS scores. It was concluded pump therapy is associated with improvements in medical and psychological variables. While a reduction in both diabetes emotional distress, and worries and behaviours related to fear of hypoglycaemia appear to be unrelated to a reduction in HbA1c, the overall burden of diabetes indicated by diabetes distress and fear of hypoglycaemia is reduced significantly 12 months after initiation of insulin pump therapy. Copyright © 2017 John Wiley & Sons.

Psychosocial factors associated with HbA1c in adults with insulin pump‐treated type 1 diabetes: a systematic review

“…Shaban et al . [12] assessed diabetes distress using the 20‐item Problem Areas In Diabetes (PAID) questionnaire, with each item being rated on a five‐point Likert scale, before and 12 months after insulin pump initiation [25]. During this time period, significant reductions in diabetes distress and HbA 1c were obtained, however, the changes in the variables were unrelated ( r = 0.02).…”

“…The most widely investigated psychosocial factor was fear of hypoglycaemia, which was included in three of the eight studies [11–13]. One study used the Hypoglycemia Fear Survey (HFS) and two used the revised version of the survey, HFS‐II [14,15].…”

“…Likewise, no association between change in HFS‐II scores and change in HbA 1c level from insulin pump initiation to 1‐year follow‐up (HFS‐II worry subscale: r = 0.01; HFS‐II behaviour subscale: r = 0.05) was detected by Shaban et al . [12], despite highly significant improvements in both variables. It should be mentioned, however, that the HFS‐II response rate was only 24%.…”

“…Diabetes distress, that is, the perceived emotional burden of living with and managing diabetes, for example, making several insulin dosing decisions every day, was investigated in two studies using two different assessment tools [12,23]. Khan et al .…”

“…In the current study sample, Shaban et al . [12], found a positive association between diabetes distress and HbA 1c by use of DDS‐2, whereas Khan et al . [23] found no association by use of PAID.…”