Hypoglycemia Subtypes in Type 1 Diabetes: An Exploration of the Hypoglycemia Fear Survey-II

Author:

Maclean Rory H.12,Jacob Peter12,Choudhary Pratik13,Heller Simon R.4,Toschi Elena5,Kariyawasam Dulmini6,Brooks Augustin7,Kendall Mike8,de Zoysa Nicole2,Gonder-Frederick Linda A.9,Amiel Stephanie A.12ORCID

Affiliation:

1. Department of Diabetes, Faculty of Life Sciences, King’s College London, London, U.K.

2. King’s College Hospital NHS Foundation Trust, London, U.K.

3. University of Leicester, Leicester, U.K.

4. University of Sheffield, Sheffield, U.K.

5. Joslin Diabetes Centre, Harvard Medical School, Boston, MA

6. Guy’s and St Thomas’ Hospital, London, U.K.

7. University Hospitals Dorset NHS Foundation Trust, Bournemouth, U.K.

8. HARPdoc Patient Group, Department of Diabetes, King’s College London, London, U.K.

9. Center for Diabetes Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA

Abstract

OBJECTIVE The Hypoglycemia Fear Survey-II (HFS-II) is a well-validated measure of fear of hypoglycemia in people with type 1 diabetes. The aim of this study was to explore the relationships between hypoglycemia worries, behaviors, and cognitive barriers to hypoglycemia avoidance and hypoglycemia awareness status, severe hypoglycemia, and HbA1c. RESEARCH DESIGN AND METHODS Participants with type 1 diabetes (n = 178), with the study population enriched for people at risk for severe hypoglycemia (49%), completed questionnaires for assessing hypoglycemia fear (HFS-II), hyperglycemia avoidance (Hyperglycemia Avoidance Scale [HAS]), diabetes distress (Problem Areas In Diabetes [PAID]), and cognitive barriers to hypoglycemia avoidance (Attitudes to Awareness of Hypoglycemia [A2A]). Exploratory factor analysis was applied to the HFS-II. We sought to establish clusters based on HFS-II, A2A, Gold, HAS, and PAID using k-means clustering. RESULTS Four HFS-II factors were identified: Sought Safety, Restricted Activity, Ran High, and Worry. While Sought Safety, Restricted Activity, and Worry increased with progressively impaired awareness and recurrent severe hypoglycemia, Ran High did not. With cluster analysis we outlined four clusters: two clusters with preserved hypoglycemia awareness were differentiated by low fear/low cognitive barriers to hypoglycemia avoidance (cluster 1) versus high fear and distress and increased Ran High behaviors (cluster 2). Two clusters with impaired hypoglycemia awareness were differentiated by low fear/high cognitive barriers (cluster 3) as well as high fear/low cognitive barriers (cluster 4). CONCLUSIONS This is the first study to define clusters of hypoglycemia experience by worry, behaviors, and cognitive barriers to hypoglycemia avoidance. The resulting subtypes may be important in understanding and treating problematic hypoglycemia.

Publisher

American Diabetes Association

Subject

Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine

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