Predictors of fear of hypoglycemia in adolescents with type 1 diabetes and their parents (original) (raw)
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Abstract OBJECTIVE: To explore the fear of hypoglycemia (FOH) and anxiety-related emotional disorders and their risk factors among adolescents with type 1 diabetes mellitus (T1DM). SUBJECTS AND METHODS: A cross-sectional study was conducted among 187 adolescents (aged 13-18 years; 92 males, 95 females) with T1DM at the Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia, from June 2013 to February 2014. The participants were interviewed using FOH and Screen for Child Anxiety-Related Disorders (SCARED) scales. RESULTS: Females had significantly higher scores on all FOH and SCARED subscales compared to males. The mean scores for many subscales of FOH and SCARED were higher in the older age group (16-18 years), in those under multiple-dose injection (MDI) treatment (compared with the insulin pump treatment), and in those with a longer duration of T1DM. Similarly, significant differences were observed in those with high frequencies of hypoglycemia, passing out, hypoglycemia while asleep and awake, and hypoglycemia in front of friends and at school. Regression analysis revealed that higher age, female gender, MDI treatment, longer duration of T1DM, higher frequencies of hypoglycemia, passing out, hypoglycemia while asleep and awake, and hypoglycemia in front of friends and at school were the risk factors associated with the majority of the FOH and SCARED subscales. The behavior of the FOH subscale correlated with all the subscales of SCARED except the subscale of generalized anxiety disorder. Similarly, the FOH subscale of worry significantly correlated with all the subscales of SCARED. CONCLUSION: The strongest determinants of higher risk for the majority of the FOH and SCARED subscales were higher age, female gender, MDI treatment, longer duration of T1DM, higher frequency of hypoglycemia, passing out due to hypoglycemia, hypoglycemia while asleep and awake, and hypoglycemia in front of friends and at school. © 2015 S. Karger AG, Basel.
Assessing fear of hypoglycemia in children with Type 1 diabetes and their parents
Diabetes Management, 2011
This article summarizes the literature on fear of hypoglycemia in pediatric Type 1 diabetes and the assessment of this fear in both children with Type 1 diabetes and their parents. The most common instrument for assessing fear of hypoglycemia in this population is the children's and parent's versions of the Hypoglycemia Fear Survey (HFS), although studies using other assessment measures are also reviewed. Studies using this survey have identified variables contributing to fear of hypoglycemia in children with Type 1 diabetes and their parents, such as history of frequent or traumatic hypoglycemia, as well as trait anxiety. In addition to this summary of the literature, new data are presented supporting the reliability of hypoglycemic fear assessment in younger children and comparing fear of hypoglycemia in children in different age groups (6-18 years old) and their parents. Also reviewed are studies investigating the relationship between fear of hypoglycemia and diabetes control, which have yielded inconsistent results. Given the potential importance of fear of hypoglycemia in pediatric diabetes, there has been limited research in this area.
Journal of health psychology, 2016
This study explored the association between parental fear of hypoglycemia, anxiety, and subjective well-being in parents of children and adolescents with type 1 diabetes. A total of 120 mothers and 79 fathers participated. Mothers' and fathers' fear of hypoglycemia was significantly associated with anxiety and negative affect as well as with worse glycemic control in child. Paired-samples t-test showed that mothers were more involved in diabetes management and reported more fear and anxiety compared to fathers, but they did not differ in worries about hypoglycemia. The findings suggest screening for fear of hypoglycemia and subjective well-being in all parents regardless of whether their child experienced severe hypoglycemia.
Understanding the construct of fear of hypoglycemia in pediatric type 1 diabetes
Journal of pediatric psychology
Fear of hypoglycemia (FoH) can be a significant barrier to glycemic control in pediatric type 1 diabetes (T1D). This study aimed to explore underlying constructs of the Hypoglycemia Fear Survey (HFS) for parents (PHFS) and children (CHFS). Data were aggregated from five studies of 259 youth with T1D and 250 parents. Exploratory Factor Analysis was used to determine the underlying factors of the CHFS and PHFS. Similar four-factor solutions were found for the CHFS and PHFS. Both subscales consisted of two factors: Behavior Subscale (1) behaviors used to keep blood glucose (BG) high to prevent hypoglycemia (Maintain High BG) and (2) other actions to avoid hypoglycemia (Avoidance); Worry Subscale (1) concerns about helplessness (Helplessness) and (2) negative social consequences associated with hypoglycemia (Social Consequences). These constructs provide a more comprehensive understanding of pediatric FoH and have implications for interventions aimed at reducing FoH in this population.
Journal of Pediatric Endocrinology and Metabolism, 2005
Background For people with type 1 diabetes, there is no alternative to treatment with insulin. The major side effect of insulin is severe hypoglycaemia (SH), when the patient needs help or even becomes unconscious. Material We have studied a geographic population of yearly 130-140 unselected type 1 diabetes patients aged 1-18 years during 1992-1999. They were intensively treated with 87-96% on 4-7 daily insulin doses, combined with active selfcontrol, psychosocial support and problem-based education from onset. Average HbA1c was 6.5 with Mono-S standard (1.15% below DCCT level). Methods We evaluated use of a prospective patient questionnaire for continuous long-term registration of treatment and outcome data and analysed HbA1c, SH and other variables. Over years, 95-100% response rate was achieved. We used also temporary questionnaires. Results We found SH with unconsciusness reported from on average 11% of patients yearly, SH without unconsciousness but needing assistance from on average 36% yearly and weak associations to HbA1c, such as a relative risk of SH 1.24 for yearly mean HbA1c <7.0% compared to ≥7.0%. There was a seasonal variation in HbA1c (p=0.023) and incidence of SH. The strongest predictor for SH was SH during the previous year (r=0.38, p<0.0001). The impact from SH showed great variation, and 20-30% of events led to practical disturbancies for parents and/or other people. Hospital visits took place only at 5% and hospitalisations at 3% of events. Social activities for patients were cancelled after 10% of events. Increased worry for patients was reported after 8% of events, bad sleep after 7%. We estimated the average socioeconomic cost for SH at EURO 239 per event of SH with unconsciousness, and EURO 63 per event of SH without unconsciousness but needing assistance. Mass-distributed self-study material (brochures and videos) aimed at the prevention of SH without compromising metabolic control reached high dissemination and was widely appreciated by patients. The material copy cost was only EURO 7 per patient. It also seems to have contributed to a decrease in SH with unconsciousness from yearly 13% of patients before to 9% after intervention (3-years average), but controlled studies are needed. Conclusions We conclude that SH remains a very serious problem of multifactorial aethiology. It causes considerable discomfort and costs. Systematic patient education might reduce the incidence. Interventions using mass-distribution of high quality self-study material such as videos and brochures seem to have a potential to be cost-effective. There is a great patient/consumer interest in high quality-and advanced information/education materials.
Fear of hypoglycemia: relationship to hypoglycemic risk and psychological factors
Acta Diabetologica, 2014
Objective The major aims of this study were to examine (1) the association between fear of hypoglycemia (FOH) in adults with type 1 diabetes with demographic, psychological (anxiety and depression), and disease-specific clinical factors (hypoglycemia history and unawareness, A 1c ), including severe hypoglycemia (SH), and (2) differences in patient subgroups categorized by level of FOH and risk of SH.
2021
Objective: Hypoglycemia is a common acute complication of type 1 diabetes (T1D), which may cause seizure, loss of consciousness, and temporary motor or sensory impairment. Glucagon administration is an effective way of treating severe hypoglycemia, especially in a free-living setting. Nonetheless, families have difficulties in managing severe hypoglycemia due to their anxiety and challenges with current glucagon administration techniques. The aim of the current study was to explore the associations between parental fear of hypoglycemia (FoH) and their general anxiety level, and in particular, their attitudes towards and thoughts on glucagon administration. Methods: Parents of children with T1D completed questionnaires assessing background and clinical information, FoH, generalized anxiety disorder (GAD) and parental anxiety for glucagon administration (PAGA). Results: Sixty-eight parents participated. Positive correlations were found between parental GAD-7 score and both FoH and the...
Medical Journal of the Islamic Republic of Iran
Background: This study was designed to determine the level of fear of hypoglycemia (FoH), pediatric parenting stress and selfefficacy in parents of children with type 1 diabetes (T1D). Methods: In this cross-sectional study, 61 families of children with T1D who had been diagnosed for at least 6 months recruited from "Gabric Diabetes Education Association" in Tehran. Sixty mothers and 41 fathers of 61 children (26 girls, age: 6.0-12.7 years) were assessed using the Hypoglycemia Fear Survey-Parent (HFS-P), Pediatric Inventory for Parents (PIP) and Self-Efficacy for Diabetes Scale-Parent (SED-P) questionnaires. Pearson correlation analysis was used to compute the correlation between HFS-P, PIP and SED-P scores separately for mother and fathers. Results: Only 8.3% of children had controlled diabetes. Internal reliability of the Persian version of all questionnaires was good. FoH were higher for mothers. Mothers whose children had diabetes for less than two years had significantly lower mean HFS-Behavior subscale (HFS-B) scores than mothers whose children had diabetes for more than two years. There was a positive correlation between fathers' mean HFS-B score and children's total insulin dose per day. Parents' FoH score was positively correlated with increased pediatric parenting stress. Findings also showed considerable emotional distress in 51% of mothers and 29.7% of fathers. Frequency of selfmonitoring blood glucose tests (SMBG) correlated negatively with HbA1c. Conclusion: We concluded that parents with high levels of FoH and stress may benefit from diabetes education. Important implications for education are considering psychological adjustment, recognizing diabetes-related fear and stress in parents, encouraging fathers to become actively involved in the child's diabetes management and emphasizing the importance of SMBG.