Understanding the Construct of Fear of Hypoglycemia in Pediatric Type 1 Diabetes

Shepard, Jaclyn A.; Vajda, Karen; Nyer, Maren; Clarke, William L.; Gönder-Frederick, Linda

doi:10.1093/jpepsy/jsu068

Cited by 62 publications

(67 citation statements)

References 29 publications

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“…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.…”

Section: Discussionsupporting

confidence: 89%

“…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.…”

Section: Discussionsupporting

confidence: 89%

“…snacking before bedtime). Moreover, parental fear of hypoglycaemia has been linked to emotional parental distress 4, 5, 6.…”

Section: Introductionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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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.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 89%

“…snacking before bedtime). Moreover, parental fear of hypoglycaemia has been linked to emotional parental distress 4, 5, 6.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

et al. 2018

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“…Interestingly, in a recent study with parents and adolescents with T1D, researchers identified a two-factor structure within the HFS behavior subscale corresponding to potentially adaptive (e.g., ''Avoid being alone when blood glucose could drop'') versus maladaptive (e.g., ''Try to run blood sugars a little high to be safe'') behaviors. 20 Although we did not directly test for these subfactors in our analyses, items 2, 5, and 9 do reflect potentially adaptive behaviors to prevent low blood glucose, which may explain why they did not load on a factor that also included potentially maladaptive behaviors. Thus, as a future study, it may be important to confirm if a two-subfactor structure exists for the HFS-PYC behavior scale in a larger sample of parents.…”

Section: Discussionmentioning

confidence: 99%

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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Development and Validation of a Tool to Identify Patients With Type 2 Diabetes at High Risk of Hypoglycemia-Related Emergency Department or Hospital Use

et al. 2017

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Background: Hypoglycemia inpatient admissions are costly and potentially preventable. Using established risk factors for hypoglycemia, we set out to develop a risk-scoring tool using the data from an Asian population. Methods:In this historical cohort study, we extracted the data of 47,404 type 2 diabetes mellitus (T2DM) patients with complete data based on their last visit in 2012 at selected National Healthcare Group Polyclinics in Singapore. The outcome variable is the occurrence of any hypoglycemia inpatient admission within 6 months from their last visit in 2012. We entered the following potential predictors into a logistic regression model: 1) Age; 2) Largest reduction in glycated hemoglobin within 1 year; 3) Last body mass index; 4) Last estimated glomerular filtration rate; 5) Usage of sulphonylurea and/or insulin; 6) Last glycated hemoglobin; 7) Any previous hypoglycemia inpatient admission in the past 1 year. The relative weightage of predictors were compared, and the model parameters were subsequently converted to a simple risk score (range: 0 to 100). Results:We found predictors 1 to 5 to be statistically significant for subsequent hypoglycemia inpatient admission. In our study population, based on a sensitivity of 73.8% and a specificity of 73.1%, a cutoff score of 38 was selected. The area under the receiver-operating characteristic curve was 0.809 (CI: 0.763 -0.855). Conclusions:A risk score using commonly available clinical data can help to identify those at risk of hypoglycemia inpatient admission with satisfactory level of accuracy. This score needs to be further validated with randomized controlled studies.

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Understanding the Construct of Fear of Hypoglycemia in Pediatric Type 1 Diabetes

Abstract: These constructs provide a more comprehensive understanding of pediatric FoH and have implications for interventions aimed at reducing FoH in this population.

Cited by 62 publications

References 29 publications

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

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

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

Development and Validation of a Tool to Identify Patients With Type 2 Diabetes at High Risk of Hypoglycemia-Related Emergency Department or Hospital Use

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