Fear more than reality of hypoglycemia impacts QoL in adolescents
medwireNews: Fear of hypoglycemia, rather than the actual frequency of hypoglycemic events, may impact diabetes-specific quality of life (QoL) in adolescents, say researchers.
“Adolescents who report higher levels of fear of hypoglycaemia and are thus more worried about hypoglycaemia and its consequences, may be more likely to engage in hypoglycaemia avoidance behaviors (i.e., avoiding social or physical activities), that can impair their QoL,” the team writes in Diabetic Medicine.
“This suggests that fear of hypoglycaemia, and not solely recent events and experiences with hypoglycaemia, should be measured in clinical care, as this fear is a potentially modifiable factor that can strongly contribute to reduced diabetes-specific QoL.”
Manon Coolen (University of Southern Denmark, Odense) and colleagues surveyed 96 adolescents (46% male) with type 1 diabetes. They were aged between 12 and 18 years and had an average glycated hemoglobin (HbA1c) level of 58 mmol/mol (7.5%).
Response on the Hypoglycaemia Fear Survey – Children version revealed that around 20% of these study participants had experienced at least one episode of severe hypoglycemia (requiring third-party assistance) within the preceding 12 months, with a range of zero to 20 episodes. Also, 87% had experienced at least one episode that they had treated themselves within the preceding 6 months, with a range of zero to 200.
The frequency of severe hypoglycemia significantly correlated with fear of hypoglycemia, but the frequency of self-treated hypoglycemia did not.
The researchers note that the rate of self-treated hypoglycemia episodes “was relatively low” in their cohort.
“As self-treated hypoglycaemia is common for adolescents with diabetes, it is possible that a potential negative impact of self-treated hypoglycaemia only occurs in adolescents who experience more frequent self-treated events,” they suggest.
Notably, fear of hypoglycemia, rather than hypoglycemia frequency, was significantly associated with diabetes-specific QoL, measured on the Pediatric Quality of Life Diabetes Module 3.2.
As well as stemming from past experiences, “[f]ear of hypoglycaemia can also be an anticipatory anxiety about future events and might also occur when reading or hearing about severe events, irrespective of one’s own experiences,” note Coolen et al.
In the basic model, age, sex, and HbA1c explained 14% of the variance in the adolescents’ QoL, and this was not improved by adding in the frequency of severe and self-treated hypoglycemia, despite frequency of severe hypoglycemia being significantly associated with QoL.
However, adding the perceived severity of severe and self-treated hypoglycemia improved the model, to explain 26% of the variance in QoL. Moreover, this rendered the association between severe hypoglycemia and QoL nonsignificant.
Finally, adding fear of hypoglycemia further improved the model, to explain 52% of the variance in QoL, and this addition resulted in all previous associations becoming nonsignificant.
“Despite limitations, the results highlight the need to be [aware of and assess] fear of hypoglycaemia in clinical care, as only fear of hypoglycaemia was independently related to diabetes QoL,” conclude the researchers.
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