Factors associated with fear of hypoglycaemia among the T1D Exchange Glu population in a cross-sectional online survey

Abstract

ObjectivesFear of hypoglycaemia (FoH) has been associated with suboptimal diabetes management and health outcomes. This study investigated factors associated with behavioural and emotional aspects of FoH among adults living with type 1 diabetes (T1D) mellitus.DesignCross-sectional study.SettingOnline survey hosted on T1D Exchange Glu, an online community for patients living with T1D mellitus.MeasuresThe Hypoglycaemia Fear Survey II-short form and the Hypoglycaemic Attitudes and Behaviour Scale were used to assess FoH. Multivariable regressions were performed on assessment scores.ResultsThe study included 494 participants (mean±SD age 43.9±12.2 years, duration of T1D mellitus 16.6±16.8 years, self-reported glycosylated hemoglobin (HbA1c) 6.9%±0.8% (52±9 mmol/mol)), 63% men, 89% on insulin pump, 25% experienced a severe hypoglycaemic event in the last 6 months. Multivariable regression analyses showed higher anxiety, depression severity and diabetes distress were independently associated with FoH (all p<0.01). Longer diabetes duration was associated with lower FoH (p<0.01). Past experience with severe hypoglycaemia was associated with higher worry of hypoglycaemia (p<0.01) but not avoidance behaviour (ns).ConclusionsThese results highlighted the multifaceted nature of FoH, which warrants further discussion between providers and patients to uncover drivers of and actions required to reduce FoH and improve patient care and outcomes.

The experience of a severe hypoglycaemic event from the perspective of people with diabetes and their caregivers: “What am I going to do?”

“…Additionally, the finding that people with diabetes/caregivers often learn to treat SH through experience—figuring it out as they go—and that people with diabetes/caregiver‐healthcare provider discussions regarding treatment plans are lacking aligns with the CRASH Study, in which substantial shares of people with diabetes reported not discussing recent SH events with healthcare providers 10,16–18 . Other studies have also reported on the need for providing more education and support to people with diabetes and their caregivers regarding the management of SH events 19 . These findings suggest that healthcare providers’ awareness regarding the challenges experienced by people with diabetes and their caregivers around managing SH events may be limited.…”

“…The emotional challenges reported by participants in this study, particularly caregivers, and the need to make life changes so a person with diabetes is not alone during a future SH event are consistent with the findings reported in the literature. 5,6,19,[23][24][25]27,28 Additionally, the finding that people with diabetes/caregivers often learn to treat SH through experience-figuring it out as they go-and that people with diabetes/caregiver-healthcare provider discussions regarding treatment plans are lacking aligns with the CRASH Study, in which substantial shares of people with diabetes reported not discussing recent SH events with healthcare providers. 10,[16][17][18] Other studies have also reported on the need for providing more education and support to people with diabetes and their caregivers regarding the management of SH events.…”

“…In one study, 16 people with diabetes in Canada were interviewed about their roles in preventing or self‐managing hypoglycaemia 6,18 . Other studies have focused on the fear of hypoglycaemia or the impact of hypoglycaemia and impaired awareness about hypoglycaemia on the day‐to‐day lives of people with type 1 diabetes and their family members 19–27 …”

The Future of Clinical Islet Transplantation in the United States

“…Fears of hypoglycemia are more commonly associated with T1D than other types of diabetes [28]. On average, T1D patients suffer from two hypoglycemic episodes per week with approximately one severe episode per year [29].…”

“…On average, T1D patients suffer from two hypoglycemic episodes per week with approximately one severe episode per year [29]. Severe hypoglycemic episodes requiring the action or assistance of another person may occur day or night and can result in seizures, altered consciousness, loss of consciousness, stroke, coma, or even in rare cases, death [28,30]. As many as 10% of deaths attributed to T1D are due to hypoglycemia [29].…”