Health Sciences Center, University of Virginia, Charlottesville, VA, USA.
Diabet Med. 2013 May;30(5):603-9. doi: 10.1111/dme.12129. Epub 2013 Feb 28.
The Hypoglycemia Fear Survey (HFS)-II Behaviour and Worry subscales were developed to measure behaviours and anxiety related to hypoglycaemia in diabetes. However, previous studies found lower reliability in the HFS Behaviour subscale and inconsistent relationships with glucose control. The purpose of this study was to conduct extensive analyses of the internal structure of the HFS Behaviour subscale's internal structure and its relationships with diabetes outcomes, including HbA1c and episodes of severe hypoglycaemia.
HFS-II survey data from 1460 adults with Type 1 diabetes were collected from five countries. This aggregated sample underwent exploratory factor analysis and item analysis to determine the internal structure of the survey and subscales.
A three-factor solution showed the best fit for the HFS, with two subscales emerging from the HFS Behaviour representing tendencies towards (1) maintenance of high blood glucose and (2) avoidance of hypoglycaemic risks by other behaviours, and a third single HFS Worry subscale. Subscale item analysis showed excellent fit, separation and good point-measure correlations. All subscales demonstrated acceptable (0.75) to excellent (0.94) internal reliability. HbA(1c) correlated with Maintain High Blood Glucose subscale scores, r = 0.14, P < 0.001, and severe hypoglycaemia frequency correlated with all subscales.
The HFS Worry subscale measures one construct of anxiety about various aspects of hypoglycaemia. In contrast, the HFS Behaviour subscale appears to measure two distinct aspects of behavioural avoidance to prevent hypoglycaemia, actions which maintain high blood glucose and other behaviours to avoid hypoglycaemic risk. These results demonstrate the clinical importance of the HFS Behaviour subscales and their differential relationships with measures of diabetes outcome such as HbA1c .
低血糖恐惧调查（HFS）-II 行为和担忧子量表旨在测量糖尿病患者与低血糖相关的行为和焦虑。然而，先前的研究发现 HFS 行为子量表的可靠性较低，并且与血糖控制的关系不一致。本研究的目的是对 HFS 行为子量表的内部结构及其与包括 HbA1c 和严重低血糖发作在内的糖尿病结局的关系进行广泛分析。
从五个国家收集了 1460 名 1 型糖尿病成人的 HFS-II 调查数据。该综合样本进行了探索性因素分析和项目分析，以确定调查和子量表的内部结构。
三因素解决方案最适合 HFS，HFS 行为出现两个子量表，代表维持高血糖的倾向（1）和通过其他行为避免低血糖风险的倾向（2），以及第三个单独的 HFS 担忧子量表。子量表项目分析显示出良好的拟合度、分离度和良好的点度量相关性。所有子量表均表现出可接受的（0.75）到优秀的（0.94）内部可靠性。HbA（1c）与维持高血糖子量表评分相关，r = 0.14，P <0.001，严重低血糖发作频率与所有子量表相关。
HFS 担忧子量表测量对各种低血糖方面的焦虑的一个结构。相比之下，HFS 行为子量表似乎测量了两种不同的行为回避方面，以防止低血糖，这些行为维持高血糖和其他行为以避免低血糖风险。这些结果表明 HFS 行为子量表的临床重要性及其与 HbA1c 等糖尿病结局测量的差异关系。
