Liu Jingwen, Bispham Jeoffrey, Fan Ludi, Poon Jiat-Ling, Hughes Allyson, Mcauliffe-Fogarty Alicia, Varnado Oralee, Mitchell Beth
Patient-Centered Research, T1D Exchange, Boston, Massachusetts, USA.
Lilly Diabetes, Eli Lilly and Company, Indianapolis, Indiana, USA.
BMJ Open. 2020 Sep 6;10(9):e038462. doi: 10.1136/bmjopen-2020-038462.
Fear of hypoglycaemia (FoH) has been associated with suboptimal diabetes management and health outcomes. This study investigated factors associated with behavioural and emotional aspects of FoH among adults living with type 1 diabetes (T1D) mellitus.
Cross-sectional study.
Online survey hosted on T1D Exchange Glu, an online community for patients living with T1D mellitus.
The Hypoglycaemia Fear Survey II-short form and the Hypoglycaemic Attitudes and Behaviour Scale were used to assess FoH. Multivariable regressions were performed on assessment scores.
The study included 494 participants (mean±SD age 43.9±12.2 years, duration of T1D mellitus 16.6±16.8 years, self-reported glycosylated hemoglobin (HbA1c) 6.9%±0.8% (52±9 mmol/mol)), 63% men, 89% on insulin pump, 25% experienced a severe hypoglycaemic event in the last 6 months. Multivariable regression analyses showed higher anxiety, depression severity and diabetes distress were independently associated with FoH (all p<0.01). Longer diabetes duration was associated with lower FoH (p<0.01). Past experience with severe hypoglycaemia was associated with higher worry of hypoglycaemia (p<0.01) but not avoidance behaviour (ns).
These results highlighted the multifaceted nature of FoH, which warrants further discussion between providers and patients to uncover drivers of and actions required to reduce FoH and improve patient care and outcomes.
低血糖恐惧（FoH）与糖尿病管理欠佳及健康结局相关。本研究调查了1型糖尿病（T1D）成年患者中与FoH的行为和情绪方面相关的因素。
横断面研究。
在T1D Exchange Glu（一个T1D患者在线社区）上进行的在线调查。
使用低血糖恐惧调查问卷II简表和低血糖态度与行为量表来评估FoH。对评估分数进行多变量回归分析。
该研究纳入了494名参与者（平均±标准差年龄43.9±12.2岁，T1D病程16.6±16.8年，自我报告的糖化血红蛋白（HbA1c）为6.9%±0.8%（52±9 mmol/mol）），63%为男性，89%使用胰岛素泵，25%在过去6个月内经历过严重低血糖事件。多变量回归分析显示，较高的焦虑、抑郁严重程度和糖尿病困扰与FoH独立相关（均p<0.01）。糖尿病病程较长与较低的FoH相关（p<0.01）。过去严重低血糖的经历与较高的低血糖担忧相关（p<0.01），但与回避行为无关（无统计学意义）。
这些结果突出了FoH的多面性，这需要医疗服务提供者和患者之间进一步讨论，以揭示降低FoH以及改善患者护理和结局所需的驱动因素和行动。
