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Impact of fear of hypoglycemia on self-management practices and glycemic control among adolescents with type 1 diabetes mellitus

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Abstract

Aim

The aim of the present study was to assess determinants of fear of hypoglycemia (FOH) and its impact on diabetes self-management practices and glycemic control among adolescents with type 1 diabetes mellitus (T1DM).

Subject and methods

A cross-sectional study was conducted in four diabetes outpatient clinics. Adolescents with T1DM were included. The Hypoglycemia Fear Survey for Children (CHFS) and Diabetes Self-Management Questionnaire (DSMQ) were used. Glycosylated hemoglobin (HbA1c) records were obtained.

Results

Out of the 400 participants, 77.6% had suboptimal glycemic control (HbA1c > 7%). FOH was significantly higher among females, adolescents with suboptimal glycemic control, higher frequency of hypoglycemic episodes, and negative experiences with hypoglycemia (p ≤ 0.05). Among the DSMQ subscales, medication adherence had the best score, whereas dietary control had the lowest one. Female sex, older age group, late onset of T1DM, suboptimal glycemic control, hospitalization due to T1DM, and existence of co-morbidities were significantly associated with undesirable self-management practice (p ≤ 0.05). The total CHFS score was correlated positively with glucose monitoring (Pearson’s correlation coefficient (r) = 0.104, p = 0.038), and negatively with health-care utilization (r = –0.140, p = 0.005). Hypoglycemia-avoidance behaviors were positively correlated with the DSMQ total score (r = 0.120, p = 0.016) and glucose monitoring (r = 0.201, p = 0.000). Hypoglycemia-related worries were negatively correlated with health-care utilization (r = –0.150, p = 0.003) and medication adherence (r = –0.115, p = 0.022).

Conclusions

Developmentally appropriate diabetes education should target adolescents with diabetes based on their needs, worries, and concerns to alleviate FOH and improve self-management behaviors.

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Data availability

The data that support the findings of this study are available on request from the corresponding author.

Abbreviations

FOH:

Fear of hypoglycemia

T1DM:

Type 1 diabetes mellitus

CHFS:

Hypoglycemia Fear Survey for Children

DSMQ:

Diabetes Self-Management Questionnaire

HbA1c:

Glycosylated hemoglobin

LMICs:

Low- and middle-income countries

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Acknowledgements

The authors are grateful to the adolescents with diabetes recruited from diabetes outpatients’ clinics affiliated with the Health Insurance Organization in Alexandria, Egypt, for participation in the current study.

Funding

The underlying research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Adolescent and School Health, Family Health Department, High Institute of Public Health, Alexandria University, Alexandria, 21561, Egypt

    Noha Fadl, Kholoud Tayel & Gehan Mounir

  2. Mental Health, Family Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt

    Medhat Attia

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  1. Noha Fadl
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Contributions

Conceptualization, Noha Fadl, Kholoud Tayel, Medhat Attia, Gehan Mounir; Methodology, Noha Fadl; Data Collection, Noha Fadl; Data Cleaning and Data Analysis, Noha Fadl; Data Curation, Noha Fadl; Writing–Original Draft Preparation, Noha Fadl; Writing–Review & Editing, Noha Fadl, Kholoud Tayel, Medhat Attia, Gehan Mounir.; Visualization, Noha Fadl, Kholoud Tayel, Medhat Attia, Gehan Mounir. All authors have read and agreed to the published version of the manuscript.

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Correspondence to Noha Fadl.

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Ethics approval

Approval from the Ethics Committee of the High Institute of Public Health, Alexandria University, Egypt was obtained before conducting the current study.

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Written consent was obtained from parents/caregivers of all study participants after explanation of the purpose and benefits of the research involved. Anonymity and confidentiality were ensured and maintained.

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The authors declare that they have no conflict of interest.

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Kholoud Tayel is deceased.

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Fadl, N., Tayel, K., Attia, M. et al. Impact of fear of hypoglycemia on self-management practices and glycemic control among adolescents with type 1 diabetes mellitus. J Public Health (Berl.) (2024). https://doi.org/10.1007/s10389-024-02201-6

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