Nighttime is the worst time: Parental fear of hypoglycemia in young children with type 1 diabetes

Abstract

Background Fear of hypoglycemia is common in parents of young children with type 1 diabetes (T1D), but little is known about the specific fears that parents most often experience. Hypoglycemia fear has been associated with poorer glycemic control in older children, though not yet studied in a large cohort of very young children. Materials and Methods Parents of 549 children <7 years (mean 5.2 ± 1.2 years [19% <3 years]) with a mean diabetes duration of 2.4 ± 1.0 years (range 1‐6 years) and mean HbA1c 8.2% ± 1.1% (66 ± 12 mmol/mol) registered in the T1D Exchange completed the worry scale of the Hypoglycemia Fear Survey modified for parents (HFS‐P). Results Mean parental fear of hypoglycemia worry score was 36.1 ± 23.1 (possible range 0‐100), with most frequent worries related to the child having a low while asleep and the child not recognizing a low. The mean worry score was not associated with the child's age, glycemic control, or recent severe hypoglycemic event. Parental worries about lows while sleeping were significantly higher in pump users than non‐users (61% vs. 45%; P < .001), and tended to be higher in CGM users than non‐users (62% vs 51%; P = .02). Conclusions The greatest worries of parents of young children with T1D were related to hypoglycemia during sleep and other times/circumstances during which it would be difficult to detect hypoglycemia. Using advanced diabetes technologies may be an effort to temper fears about hypoglycemia during sleep, though the directionality of this relationship is undetermined. Additional studies can clarify this association and leverage use of diabetes technologies to improve glycemic control.

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

“…For the present study it was unknown if children used continuous glucose monitoring devices. Although the average number of blood glucose measurements was not related to parental fear of hypoglycaemia in previous studies 5, 11, the present findings are in line with a recently published study 13. In that study, continuous glucose monitoring was unrelated to parental fear of hypoglycaemia 13.…”

“…In contrast to a previous study 5, but consistent with several other studies 4, 6, 7, 8, 9, 10, 11, 12, 13, HbA 1c was not related to parental fear of hypoglycaemia. HbA 1c was assessed by parental report, and therefore may not be reliable.…”

“…This finding is in line with studies that classifed severe hypoglycaemia as a hypoglycaemic event resulting in seizure, unconsciousness or hospital admission 5, 6, 8, 9, 11, 12, 13. Based on previous studies, the frequency of hypoglycaemia 5, 12 and hypoglycaemic events at school 8 seem to be more important factors in relation to parental fear of hypoglycaemia than severe hypoglycaemia.…”

“…Because previous research into parental fear of hypoglycaemia did not include any other parent characteristics, such as age and nationality, or had discrepancies in the categorization of educational levels 10, 13, it is not possible to relate our findings to other studies. Nevertheless, in population‐based studies, younger age, low educational level and non‐Dutch nationality have been linked to higher levels of anxiety 25, 26, 27.…”

“…Most of these studies had small sample sizes ( N ≤200) 4, 5, 8, 9, 10, 11, 12 and did not investigate demographic and clinical characteristics simultaneously 4, 6, 7, 8, 9, 10, 11, 12, 13, limiting the exploration of independent effects. In addition, the associations between parent demographic characteristics (e.g.…”