Skip to main content

Fear of Hypoglycemia in Children and Adolescents and Their Parents with Type 1 Diabetes

Abstract

Hypoglycemia is a frequent occurrence in children and adolescents with type 1 diabetes. A variety of efforts have been made to standardize the definition of hypoglycemia and to define one of its most significant psychosocial consequences—fear of hypoglycemia (FOH). In addition to documenting the experience of FOH in children and adolescents type 1 diabetes and their parents, studies have investigated the relations between FOH and glycemic control and diabetes technology use. This review provides a summary of the recent FOH literature as it applies to pediatric type 1 diabetes.

This is a preview of subscription content, access via your institution.

References

Papers of particular interest, recently published, have been highlighted as: • Of importance •• Of major importance

  1. 1.

    Shalitin S, Phillip M. Hypoglycemia in type 1 diabetes: a still unresolved problem in the era of insulin analogs and pump therapy. Diabetes Care. 2008;31 Suppl 2:S121–4.

    Article  PubMed  Google Scholar 

  2. 2.

    Seaquist ER, Anderson J, Childs B, et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes Care. 2013;36:1384–95.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Silverstein J, Klingensmith G, Copeland K, et al. Care of children and adolescents with type 1 diabetes: a statement of the American Diabetes Association. Diabetes Care. 2005;28:186–212.

    Article  PubMed  Google Scholar 

  4. 4.

    Clarke W, Jones T, Rewers A, et al. Assessment and management of hypoglycemia in children and adolescents with diabetes. Pediatr Diabetes. 2009;10 Suppl 12:134–45.

    Article  PubMed  Google Scholar 

  5. 5.

    Gonder-Frederick L, Nyer M, Shepard JA, et al. Assessing fear of hypoglycemia in children with type 1 diabetes and their parents. Diabetes Manag (Lond). 2011;1:627–39.

    Article  Google Scholar 

  6. 6.

    Wild D, von Maltzahn R, Brohan E, et al. A critical review of the literature on fear of hypoglycemia in diabetes: implications for diabetes management and patient education. Patient Educ Couns. 2007;68:10–5.

    Article  PubMed  Google Scholar 

  7. 7.

    Barnard K, Thomas S, Royle P, et al. Fear of hypoglycaemia in parents of young children with type 1 diabetes: a systematic review. BMC Pediatr. 2010;10:50.

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.••

    Martyn-Nemeth P, Schwarz Farabi S, Mihailescu D, et al. Fear of hypoglycemia in adults with type 1 diabetes: impact of therapeutic advances and strategies for prevention—a review. J Diabetes Complications. 2016;30:167–77. Review article summarizing the current literature on fear of hypoglycemia in adults with type 1 diabetes.

    Article  PubMed  Google Scholar 

  9. 9.••

    Bergenstal RM, Ahmann AJ, Bailey T, et al. Recommendations for standardizing glucose reporting and analysis to optimize clinical decision making in diabetes: the Ambulatory Glucose Profile (AGP). Diabetes Technol Ther. 2013;15:198–211. Proposes standard system for classifying blood glucose levels.

    Article  PubMed  Google Scholar 

  10. 10.

    Workgroup on Hypoglycemia ADA. Defining and reporting hypoglycemia in diabetes: a report from the American Diabetes Association Workgroup on Hypoglycemia. Diabetes Care. 2005;28:1245–9.

    Article  Google Scholar 

  11. 11.

    American Diabetes Association. Professional Practice Committee for the Standards of Medical Care in Diabetes—2016. Diabetes Care. 2016;39 Suppl 1:S107–8.

    Google Scholar 

  12. 12.

    Allen C, LeCaire T, Palta M, et al. Risk factors for frequent and severe hypoglycemia in type 1 diabetes. Diabetes Care. 2001;24:1878–81.

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Ferguson SC, Blane A, Perros P, et al. Cognitive ability and brain structure in type 1 diabetes: relation to microangiopathy and preceding severe hypoglycemia. Diabetes. 2003;52:149–56.

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Ferguson SC, Blane A, Wardlaw J, et al. Influence of an early-onset age of type 1 diabetes on cerebral structure and cognitive function. Diabetes Care. 2005;28:1431–7.

    Article  PubMed  Google Scholar 

  15. 15.

    Northam EA, Rankins D, Lin A, et al. Central nervous system function in youth with type 1 diabetes 12 years after disease onset. Diabetes Care. 2009;32:445–50.

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Geddes J, Wright RJ, Zammitt NN, et al. An evaluation of methods of assessing impaired awareness of hypoglycemia in type 1 diabetes. Diabetes Care. 2007;30:1868–70.

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Geddes J, Schopman JE, Zammitt NN, et al. Prevalence of impaired awareness of hypoglycaemia in adults with type 1 diabetes. Diabet Med. 2008;25:501–4.

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    DCCT. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977–86.

    Article  Google Scholar 

  19. 19.

    McNay EC, Cotero VE. Mini-review: impact of recurrent hypoglycemia on cognitive and brain function. Physiol Behav. 2010;100:234–8.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Weinstock RS, Xing D, Maahs DM, et al. Severe hypoglycemia and diabetic ketoacidosis in adults with type 1 diabetes: results from the T1D Exchange clinic registry. J Clin Endocrinol Metab. 2013;98:3411–9.

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Fox LA, Mubasher M, Wolfsdorf JI, et al. Characteristics of youth with type 1 diabetes with and without a parent with type 1 diabetes in the T1D exchange clinic registry. J Diabetes. 2015.

  22. 22.•

    Karges B, Kapellen T, Wagner VM et al. Glycated hemoglobin A1c as a risk factor for severe hypoglycemia in pediatric type 1 diabetes. Pediatr Diabetes. 2015. doi:10.1111/pedi.12348. Data presented on the relation between risk for severe hypoglycemia and A1C levels in children and adolescents with type 1 diabetes who were enrolled in the DPV Diabetes Prospective Follow-Up in Germany and Austria

  23. 23.

    Rewers A, Chase HP, Mackenzie T, et al. Predictors of acute complications in children with type 1 diabetes. JAMA. 2002;287:2511–8.

    Article  PubMed  Google Scholar 

  24. 24.•

    Karges B, Rosenbauer J, Kapellen T, et al. Hemoglobin A1c Levels and risk of severe hypoglycemia in children and young adults with type 1 diabetes from Germany and Austria: a trend analysis in a cohort of 37,539 patients between 1995 and 2012. PLoS Med. 2014;11:e1001742. To investigate trends in the association between severe hypoglycemia and glycemic control in the DPV Diabetes Prospective Follow-Up.

    Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Jeha GS, Karaviti LP, Anderson B, et al. Insulin pump therapy in preschool children with type 1 diabetes mellitus improves glycemic control and decreases glucose excursions and the risk of hypoglycemia. Diabetes Technol Ther. 2005;7:876–84.

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Al Hayek AA, Robert AA, Braham RB et al. Predictive risk factors for fear of hypoglycemia and anxiety-related emotional disorders among adolescents with type 1 diabetes. Med Princ Pract. 2015.

  27. 27.

    Amiri F, Vafa M, Gonder-Frederick L. Glycemic control, self-efficacy and fear of hypoglycemia among Iranian children with type 1 diabetes. Can J Diabetes. 2015;39:302–7.

    Article  PubMed  Google Scholar 

  28. 28.•

    Haugstvedt A, Wentzel-Larsen T, Aarflot M, et al. Assessing fear of hypoglycemia in a population-based study among parents of children with type 1 diabetes—psychometric properties of the hypoglycemia fear survey—parent version. BMC Endocr Disord. 2015;15:2. Examination of the psychometric properties of the Hypoglycemia Fear Survey—Parent Version in a sample of Norwegian parents.

    Article  PubMed  PubMed Central  Google Scholar 

  29. 29.

    Cox DJ, Irvine A, Gonder-Frederick L, et al. Fear of hypoglycemia: quantification, validation, and utilization. Diabetes Care. 1987;10:617–21.

    CAS  Article  PubMed  Google Scholar 

  30. 30.

    Weinstock RS, DuBose SN, Bergenstal RM, et al. Risk factors associated with severe hypoglycemia in older adults with type 1 diabetes. Diabetes Care. 2015.

  31. 31.

    Patton SR, Dolan LM, Henry R, et al. Fear of hypoglycemia in parents of young children with type 1 diabetes mellitus. J Clin Psychol Med Settings. 2008;15:252–9.

    Article  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Patton SR, Dolan LM, Henry R, et al. Parental fear of hypoglycemia: young children treated with continuous subcutaneous insulin infusion. Pediatr Diabetes. 2007;8:362–8.

    Article  PubMed  Google Scholar 

  33. 33.

    Clarke WL, Gonder-Frederick A, Snyder AL, et al. Maternal fear of hypoglycemia in their children with insulin dependent diabetes mellitus. J Pediatr Endocrinol Metab. 1998;11 Suppl 1:189–94.

    PubMed  Google Scholar 

  34. 34.

    Gonder-Frederick LA, Schmidt KM, Vajda KA, et al. Psychometric properties of the hypoglycemia fear survey-ii for adults with type 1 diabetes. Diabetes Care. 2011;34:801–6.

    Article  PubMed  PubMed Central  Google Scholar 

  35. 35.

    Cryer PE. Hypoglycemia. Pathophysiology, diagnosis and treatment. New York: Oxford University Press; 1997.

    Google Scholar 

  36. 36.

    Green LB, Wysocki T, Reineck BM. Fear of hypoglycemia in children and adolescents with diabetes. J Pediatr Psychol. 1990;15:633–41.

    CAS  Article  PubMed  Google Scholar 

  37. 37.••

    Shepard JA, Vajda K, Nyer M, et al. Understanding the construct of fear of hypoglycemia in pediatric type 1 diabetes. J Pediatr Psychol. 2014;39:1115–25. Provides additional support for the psychometric properties of the Hypoglycemia Fear Scale for Parents and Children including the demonstration of two subscales of the Behavior scale (Maintain High BG, Avoidance) and two subscales of the Worry scale (Helplessness, Social Consequences).

    Article  PubMed  PubMed Central  Google Scholar 

  38. 38.

    Gonder-Frederick LA, Fisher CD, Ritterband LM, et al. Predictors of fear of hypoglycemia in adolescents with type 1 diabetes and their parents. Pediatr Diabetes. 2006;7:215–22.

    Article  PubMed  Google Scholar 

  39. 39.

    Kamps JL, Roberts MC, Varela RE. Development of a new fear of hypoglycemia scale: preliminary results. J Pediatr Psychol. 2005;30:287–91.

    Article  PubMed  Google Scholar 

  40. 40.

    Johnson SR, Cooper MN, Davis EA, et al. Hypoglycaemia, fear of hypoglycaemia and quality of life in children with type 1 diabetes and their parents. Diabet Med. 2013;30:1126–31.

    CAS  Article  PubMed  Google Scholar 

  41. 41.

    Freckleton E, Sharpe L, Mullan B. The relationship between maternal fear of hypoglycaemia and adherence in children with type-1 diabetes. Int J Behav Med. 2014;21:804–10.

    Article  PubMed  Google Scholar 

  42. 42.

    Haugstvedt A, Wentzel-Larsen T, Graue M, et al. Fear of hypoglycaemia in mothers and fathers of children with type 1 diabetes is associated with poor glycaemic control and parental emotional distress: a population-based study. Diabet Med. 2010;27:72–8.

    CAS  Article  PubMed  Google Scholar 

  43. 43.

    Snoek FJ, Skinner TC. Psychological counselling in problematic diabetes: does it help? Diabet Med. 2002;19:265–73.

    CAS  Article  PubMed  Google Scholar 

  44. 44.

    Boyle S, Allan C, Millar K. Cognitive-behavioural interventions in a patient with an anxiety disorder related to diabetes. Behav Res Ther. 2004;42:357–66.

    Article  PubMed  Google Scholar 

  45. 45.

    Amsberg S, Anderbro T, Wredling R, et al. A cognitive behavior therapy-based intervention among poorly controlled adult type 1 diabetes patients—a randomized controlled trial. Patient Educ Couns. 2009;77:72–80.

    Article  PubMed  Google Scholar 

  46. 46.

    Gilbert RE, Fulcher G. Reduction in fear of hypoglycemia in subjects with sub-optimally controlled diabetes using a glargine insulin-based treatment regimen. Can J Diabetes. 2008;32:101–6.

    CAS  Article  Google Scholar 

  47. 47.

    Cox DJ, Gonder-Frederick L, Polonsky W, et al. Blood glucose awareness training (BGAT-2): long-term benefits. Diabetes Care. 2001;24:637–42.

    CAS  Article  PubMed  Google Scholar 

  48. 48.

    Little SA, Leelarathna L, Walkinshaw E, et al. Recovery of hypoglycemia awareness in long-standing type 1 diabetes: a multicenter 2 × 2 factorial randomized controlled trial comparing insulin pump with multiple daily injections and continuous with conventional glucose self-monitoring (HypoCOMPaSS). Diabetes Care. 2014;37:2114–22.

    CAS  Article  PubMed  Google Scholar 

  49. 49.

    Choudhary P, Rickels MR, Senior PA, et al. Evidence-informed clinical practice recommendations for treatment of type 1 diabetes complicated by problematic hypoglycemia. Diabetes Care. 2015;38:1016–29.

    Article  PubMed  PubMed Central  Google Scholar 

  50. 50.

    Barnard KD, Wysocki T, Allen JM, et al. Closing the loop overnight at home setting: psychosocial impact for adolescents with type 1 diabetes and their parents. BMJ Open Diabetes Res Care. 2014;2, e000025.

    Article  PubMed  PubMed Central  Google Scholar 

  51. 51.

    Ziegler C, Liberman A, Nimri R, et al. Reduced worries of hypoglycaemia, high satisfaction, and increased perceived ease of use after experiencing four nights of MD-Logic artificial pancreas at home (DREAM4). J Diabetes Res. 2015;2015:590308.

    Article  PubMed  PubMed Central  Google Scholar 

  52. 52.

    Barnard K, Parkin C, Young A, et al. Use of an automated bolus calculator reduces fear of hypoglycemia and improves confidence in dosage accuracy in patients with type 1 diabetes mellitus treated with multiple daily insulin injections. J Diabetes Sci Technol. 2012;6:144–9.

    Article  PubMed  PubMed Central  Google Scholar 

  53. 53.

    Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study G, Beck RW, Lawrence JM, et al. Quality-of-life measures in children and adults with type 1 diabetes: Juvenile Diabetes Research Foundation Continuous Glucose Monitoring randomized trial. Diabetes Care. 2010;33:2175–7.

    Article  Google Scholar 

  54. 54.

    Hajos TR, Polonsky WH, Pouwer F, et al. Toward defining a cutoff score for elevated fear of hypoglycemia on the hypoglycemia fear survey worry subscale in patients with type 2 diabetes. Diabetes Care. 2014;37:102–8.

    Article  PubMed  Google Scholar 

  55. 55.

    Patton SR, Dolan LM, Smith LB, et al. Pediatric parenting stress and its relation to depressive symptoms and fear of hypoglycemia in parents of young children with type 1 diabetes mellitus. J Clin Psychol Med Settings. 2011;18:345–52.

    Article  PubMed  PubMed Central  Google Scholar 

  56. 56.

    Markowitz JT, Pratt K, Aggarwal J, et al. Psychosocial correlates of continuous glucose monitoring use in youth and adults with type 1 diabetes and parents of youth. Diabetes Technol Ther. 2012;14:523–6.

    Article  PubMed  PubMed Central  Google Scholar 

  57. 57.

    Vallis M, Jones A, Pouwer F. Managing hypoglycemia in diabetes may be more fear management than glucose management: a practical guide for diabetes care providers. Curr Diabetes Rev. 2014;10:364–70.

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Kimberly A. Driscoll.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Psychosocial Aspects

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Driscoll, K.A., Raymond, J., Naranjo, D. et al. Fear of Hypoglycemia in Children and Adolescents and Their Parents with Type 1 Diabetes. Curr Diab Rep 16, 77 (2016). https://doi.org/10.1007/s11892-016-0762-2

Download citation

Keywords

  • Anxiety
  • Assessment
  • Blood glucose levels
  • Intervention
  • Youth