Department of Diabetes, Faculty of Life Sciences, King's College London, London, U.K.
King's College Hospital NHS Foundation Trust, London, U.K.
Diabetes Care. 2022 Mar 1;45(3):538-546. doi: 10.2337/dc21-1120.
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.
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.
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).
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.
低血糖恐惧调查 II 量表（HFS-II）是一种经过充分验证的 1 型糖尿病患者对低血糖恐惧的测量工具。本研究旨在探讨低血糖担忧、行为以及对低血糖回避的认知障碍与低血糖知晓状态、严重低血糖和 HbA1c 的关系。
研究纳入了 178 例 1 型糖尿病患者（研究人群中 49%存在严重低血糖风险），完成了低血糖恐惧量表（HFS-II）、高血糖回避量表（Hyperglycemia Avoidance Scale [HAS]）、糖尿病困扰量表（Problem Areas In Diabetes [PAID]）和对低血糖回避的认知障碍量表（Attitudes to Awareness of Hypoglycemia [A2A]）的评估。对 HFS-II 进行了探索性因素分析。我们试图使用 k-均值聚类法基于 HFS-II、A2A、Gold、HAS 和 PAID 建立聚类。
确定了 HFS-II 的四个因素：寻求安全、限制活动、高血糖和担忧。虽然随着意识障碍逐渐加重和反复发生严重低血糖，Sought Safety、Restricted Activity 和 Worry 会增加，但 Ran High 不会。通过聚类分析，我们概述了四个聚类：两个保留低血糖意识的聚类通过低恐惧/低血糖回避认知障碍区分（聚类 1），而高恐惧和困扰以及增加的 Ran High 行为区分（聚类 2）。两个低血糖意识受损的聚类通过低恐惧/高认知障碍（聚类 3）以及高恐惧/低认知障碍（聚类 4）区分。
这是第一项通过担忧、行为和对低血糖回避的认知障碍来定义低血糖体验聚类的研究。由此产生的亚型可能对于理解和治疗有问题的低血糖很重要。
