Fear of Hypoglycemia: Quantification, Validation, and Utilization

Cox, Daniel J.; Irvine, Audrey; Gönder-Frederick, Linda; Nowacek, George; Butterfield, John

doi:10.2337/diacare.10.5.617

Cited by 522 publications

(415 citation statements)

References 9 publications

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“…10 There was also a trend found suggesting higher worry scores for parents in the present sample when compared with published data from mothers of preadolescent youth (P = 0.07). 7 For the behavior score, parents in the present sample reported higher mean item scores than did adult patients (P £ 0.001), but lower mean item scores than mothers of conventionally managed young children and mothers of preadolescent youth (P £ 0.001).…”

Section: Hfs Score Comparisons With Published Outcomessupporting

confidence: 47%

“…We then specified a two-factor measurement model based on the original factor structure of the HFS, 10 allowing latent factors to correlate freely. Because the items used a five-point Likert scale, we modeled all items as ordinal data using the weighted least-squares mean and variance-adjusted estimation.…”

Section: Discussionmentioning

confidence: 99%

“…However, to allow for comparisons with published scores, [7][8][9][10] we adjusted for the number of subscale items by calculating a mean item score for each subscale, yielding a mean item score of 2.8 -0.88 for the worry subscale and a mean item score of 2.9 -0.69 for the behavior subscale.…”

Section: Hfs Score Comparisons With Published Outcomesmentioning

confidence: 99%

“…8,9 The HFS-PYC is a reliable and valid measure of FH adapted from an existing adult questionnaire, the Hypoglycemia Fear Survey. 9,10 In the development phase of the HFS-PYC, a five-member panel of diabetes care providers (e.g., one physician, one nurse educator, one dietitian educator, and two psychologists) reviewed potential items to ensure good content validity. Then, a preliminary form of the HFS-PYC was administered to a sample of parents of young children with T1D to determine its initial psychometrics.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Reexamining the Hypoglycemia Fear Survey for Parents of Young Children in a Sample of Children Using Insulin Pumps

Patton

Noser

Clements

et al. 2017

Diabetes Technology & Therapeutics

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Background: We update the psychometric properties of the Hypoglycemia Fear Survey-Parents of Young Children (HFS-PYC), a 26-item measure of parents' hypoglycemia fear for young children using an insulin pump. Methods: We combined three similar datasets for the analyses. The data analyzed included parents' responses to the HFS-PYC and a demographic form. For a subset of children (n = 91), we also analyzed self-monitoring of blood glucose data. We used confirmatory factor analysis (CFA) to confirm the measure's original factor structure. Additional analyses examined reliability and validity of a revised HFS-PYC for parents of young children using pumps. Results: We analyzed data from 116 parents (93% mothers). Mean child age and HbA1c were 5.2 -1.3 years and 8.2% -1.1%, respectively. CFA identified a 22-item two-factor solution (v 2 (208, n = 116) = 368.688, P < 0.001, root mean square error of approximation = 0.08, comparative fit index = 0.94, and Tucker-Lewis index = 0.93) with factors corresponding to the original subscales: worry and behavior. The revised subscales demonstrated at least adequate internal consistency (Cronbach's alpha >0.65). Correlations revealed significant negative associations between current HFS-PYC worry scores and children's mean daily blood glucose and percent of very high glucose levels per day, suggesting less fear among parents of young children with elevated glycemic levels. In addition, there was a positive association with the percent of glucose levels in target, suggesting greater hypoglycemia fear among parents of children who have better control. Conclusions: Results provide preliminary evidence for the reliability and validity of a reduced 22-item HFS-PYC for parents of children using insulin pumps.

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Section: Hfs Score Comparisons With Published Outcomessupporting

confidence: 47%

Section: Discussionmentioning

confidence: 99%

Section: Hfs Score Comparisons With Published Outcomesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Reexamining the Hypoglycemia Fear Survey for Parents of Young Children in a Sample of Children Using Insulin Pumps

Patton

Noser

Clements

et al. 2017

Diabetes Technology & Therapeutics

View full text Add to dashboard Cite

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“…No No -Neurology-sensory, Ophthalmology & Hyperglycemia sub-scales ≥75% Items DD but limited scope ('Psychology, cognitive', 'Psychology, fatigue', 'Neurology, pain', 'Cardiology' & 'Hypoglycemia' sub-scales <75% Items DD) HFS-II: Hypoglycemia Fear Survey II (Cox et al, 1987) N/A No -'Worry' sub-scale ≥75% Items DD but limited scope ('Part 2' sub-scale <75% Items DD) DQoL: Diabetes Quality of Life measure (Jacobson, Barofsky, Cleary, Rand, & The DCCT Research Group, 1988) N/A No -'Diabetes-related Worry' ≥75% Items DD but limited scope ('Impact' sub-scale <75% Items DD)…”

mentioning

confidence: 99%

What is diabetes distress and how can we measure it? A narrative review and conceptual model

Dennick

Sturt

Speight

2017

Journal of Diabetes and its Complications

134

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BackgroundDiabetes distress is the negative emotional impact of living with diabetes. It has tangible clinical importance, being associated with sub-optimal self-care and glycemic control. Diabetes distress has been operationalized in various ways and several measures exist. Measurement clarity is needed for both scientific and clinical reasons. ObjectivesTo clarify the conceptualization and operationalization of diabetes distress, identify and distinguish relevant measures, and evaluate their appropriateness for this purpose. ResultsThree measure were identified: Problem Areas in Diabetes (PAID) scale, Diabetes Distress Scale (DDS); Type I Diabetes Distress Scale (T1-DDS), Diabetes-specific Quality of Life Scale-Revised (DSQoLs-R) 'Burden and Restrictions -Daily Hassles' sub-scale, Well-being Questionnaire 28 (W-BQ 28) 'Diabetes Well-being' sub-scale, and Illness Perceptions Questionnaire -Revised (IPQ-R) 'Emotional Representations' sub-scale. Across these measures a broad spectrum of diabetes distress is captured, including distress associated with treatment regimen, food/eating, future/complications, hypoglycemia, social/interpersonal relationships, and healthcare professionals. No single measure appears fully comprehensive. Limited detail is reported of the qualitative work informing scale design, raising concerns about content validity. ConclusionsAcross the available measures diabetes distress is seemingly comprehensively assessed and measures should be considered in terms of their focus and scope to ensure the foci of interventions are appropriately targeted.

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Effect of Continuous Glucose Monitoring on Hypoglycemia in Older Adults With Type 1 Diabetes

Pratley

Kanapka

Rickels

et al. 2020

JAMA

243

168

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for the Wireless Innovation for Seniors With Diabetes Mellitus (WISDM) Study Group IMPORTANCE Continuous glucose monitoring (CGM) provides real-time assessment of glucose levels and may be beneficial in reducing hypoglycemia in older adults with type 1 diabetes. OBJECTIVE To determine whether CGM is effective in reducing hypoglycemia compared with standard blood glucose monitoring (BGM) in older adults with type 1 diabetes. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial conducted at 22 endocrinology practices in the United States among 203 adults at least 60 years of age with type 1 diabetes. INTERVENTIONS Participants were randomly assigned in a 1:1 ratio to use CGM (n = 103) or standard BGM (n = 100). MAIN OUTCOMES AND MEASURESThe primary outcome was CGM-measured percentage of time that sensor glucose values were less than 70 mg/dL during 6 months of follow-up. There were 31 prespecified secondary outcomes, including additional CGM metrics for hypoglycemia, hyperglycemia, and glucose control; hemoglobin A 1c (HbA 1c ); and cognition and patient-reported outcomes, with adjustment for multiple comparisons to control for false-discovery rate. RESULTSOf the 203 participants (median age, 68 [interquartile range {IQR}, 65-71] years; median type 1 diabetes duration, 36 [IQR, years; 52% female; 53% insulin pump use; mean HbA 1c , 7.5% [SD, 0.9%]), 83% used CGM at least 6 days per week during month 6. Median time with glucose levels less than 70 mg/dL was 5.1% (73 minutes per day) at baseline and 2.7% (39 minutes per day) during follow-up in the CGM group vs 4.7% (68 minutes per day) and 4.9% (70 minutes per day), respectively, in the standard BGM group (adjusted treatment difference, −1.9% (−27 minutes per day); 95% CI, −2.8% to −1.1% [−40 to −16 minutes per day]; P <.001). Of the 31 prespecified secondary end points, there were statistically significant differences for all 9 CGM metrics, 6 of 7 HbA 1c outcomes, and none of the 15 cognitive and patient-reported outcomes. Mean HbA 1c decreased in the CGM group compared with the standard BGM group (adjusted group difference, −0.3%; 95% CI, −0.4% to −0.1%; P <.001). The most commonly reported adverse events using CGM and standard BGM, respectively, were severe hypoglycemia (1 and 10), fractures (5 and 1), falls (4 and 3), and emergency department visits (6 and 8).CONCLUSIONS AND RELEVANCE Among adults aged 60 years or older with type 1 diabetes, continuous glucose monitoring compared with standard blood glucose monitoring resulted in a small but statistically significant improvement in hypoglycemia over 6 months. Further research is needed to understand the long-term clinical benefit.

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Fear of Hypoglycemia: Quantification, Validation, and Utilization

Cited by 522 publications

References 9 publications

Reexamining the Hypoglycemia Fear Survey for Parents of Young Children in a Sample of Children Using Insulin Pumps

Reexamining the Hypoglycemia Fear Survey for Parents of Young Children in a Sample of Children Using Insulin Pumps

What is diabetes distress and how can we measure it? A narrative review and conceptual model

Effect of Continuous Glucose Monitoring on Hypoglycemia in Older Adults With Type 1 Diabetes

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