To investigate prevalence of fear of hypoglycaemia (FoH) in adults with type 1 diabetes (T1D) and its association with severe hypoglycaemia (SH) and impaired awareness of hypoglycaemia (IAH).
Participants completed a survey while waiting for a routine appointment at one of three Melbourne diabetes specialist clinics. FoH was assessed with the Hypoglycaemia Fear Survey (HFS), including a 15-item behaviour scale (HFS-B) measuring actions to avoid hypoglycaemia, and an 18-item worry scale (HFS-W) measuring concerns about hypoglycaemia. Composite scale scores were the sum of item scores (range: 0 (never) to 4 (often)) divided by the number of items. Elevated FoH was defined as HFS-B and/or HFS-W scale scores ≥ mean+1SD. We also measured self-reported occurrence of SH (≥1 event in the past six months) and IAH (using the Gold score). Results are mean±SD.
Adults with T1D (n=427; age 38±15yrs; 53% women; diabetes duration 18±12 yrs) participated. The HFS-B and HFS-W scores were 1.2±0.5 and 1.1±0.7 respectively, with 24% having elevated FoH. Participants reporting SH and/or IAH (n=125, 30%) had greater FoH (HFS-B 1.3±0.6; HFS-W 1.4±0.7) vs. those without SH and/or IAH (n=287, 70%) (HFS-B 1.1±0.5; HFS-W 0.9±0.7; p<0.001). More specifically, participants experiencing SH and/or IAH scored higher on HFS-B items referring to behaviours compromising quality of life (e.g. limiting activities, increasing dependence on others) than those without SH and/or IAH. However, HFS-B items indicating changes in BG management to avoid low glucose levels (e.g. eating large snacks) were similar. Frequency of SH correlated positively with FoH (HFS-W r=0.29; HFS-B r=0.17, p<0.01).
Our findings showed low levels of FoH in adults with T1D attending a diabetes specialist clinic, with 24% having elevated FoH. FoH was associated with SH and IAH. Participants reporting SH and/or IAH applied behavioural strategies likely to impair their quality of life and to increase their reliance on others.