Skip to main content
SpringerLink
Log in

Fear of Hypoglycemia, Parenting Stress, and Metabolic Control for Children with Type 1 Diabetes and Their Parents

  • Published:
Journal of Clinical Psychology in Medical Settings Aims and scope Submit manuscript

Abstract

This study sets out to extend current knowledge of parenting stress and fear of hypoglycemia (FoH) in parents of children with type 1 diabetes mellitus (T1DM). We examined if the relationship between parental and children’s FoH and metabolic control, as reflected by HbA1c, is mediated by parenting stress. A total of 63 parents and children with T1DM were recruited during their routine physician’s appointment. Parents completed questionnaires on parenting stress and FoH. Children eight years and older also completed a questionnaire on FoH. HbA1c values were obtained from all children. Mediation analysis revealed an indirect association between parental FoH and HbA1c values through parenting stress (Sobel’s z = 2.42, p = .02), but no indirect association between children’s FoH and HbA1c. We concluded that parental FOH has an indirect association with the child’s metabolic control that is mediated by parenting stress. More simply, fear of hypoglycemia predicts parent stress, which in turn, predicts metabolic control.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Abidin, R. R. (1983). Parenting stress index manual. Charlottesville, VA: Pediatric Psychology Press.

  • Barnard, K., Thomas, S., Royle, P., Noyes, K., & Waugh, N. (2010). Fear of hypoglycaemia in parents of young children with type 1 diabetes: A systematic review. BMC Pediatrics, 10, 1471–2431.

    Article  Google Scholar 

  • Becker, D. J., & Ryan, C. M. (2000). Hypoglycemia: A complication of diabetes therapy in children. Trends in endocrinology and metabolism, 11(5), 198–201.

    Article  CAS  PubMed  Google Scholar 

  • Beléndez, M., & Hernández-Mijares, A. (2009). Beliefs about insulin as a predictor of fear of hypoglycaemia. Chronic Illness, 5(4), 250–256.

    Article  PubMed  Google Scholar 

  • Berhan, Y., Waernbaum, I., Lind, T., Möllsten, A., & Dahlquist, G. (2011). Thirty years of prospective nationwide incidence of childhood type 1 diabetes the accelerating increase by time tends to level off in Sweden. Diabetes, 60(2), 577–581.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Clarke, W. L., Gonder-Frederick, L. A., Snyder, A. L., & Cox, D. J. (1998). Maternal fear of hypoglycaemia in their children with insulin dependent diabetes mellitus. Journal of Pediatric Endocrinology & Metabolism, 11, 189–194.

    Article  Google Scholar 

  • Cox, J. D., Irvine, A., Gonder-Frederick, L., Nowacek, G., & Buttefield, J. (1987). Fear of hypoglycemia: Quantification, validation and utilization. Diabetes care, 10(5), 617–621.

    Article  CAS  PubMed  Google Scholar 

  • Craig, M. E., Jefferies, C., Dabelea, D., Balde, N., Seth, A., & Donaghue, K. C. (2014). Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatric Diabetes, 15(20), 4–17.

    Article  CAS  PubMed  Google Scholar 

  • Cryer, P. E., Davis, S. N., & Qhamoon, H. (2003). Hypoglycemia in diabetes. Diabetes care, 26(6), 1902–1912.

    Article  CAS  PubMed  Google Scholar 

  • DCCT Research Group (1991). Epidemiology of severe hypoglycemia in the diabetes control and complications trial. The American Journal of Medicine, 90(4), 450–459.

    Article  Google Scholar 

  • De Brock, A. J. L. L., Vermulst, A. A., Gerris, J. R. M., & Abidin, R. R. (1992). NOSI—Nijmeegse ouderlijke stress index, Handleiding experimentele versie [NOSI—Nijmegen Parenting Stress Index, Manual experimental version]. Lisse: Swets en Zeitlinger.

    Google Scholar 

  • Di Battista, A. M., Hart, T. A., Greco, L., & Gloizer, J. (2009). Type 1 diabetes among adolescents reduced diabetes self-care caused by social fear and fear of hypoglycemia. The Diabetes Educator, 35(3), 465–475.

    Article  PubMed  Google Scholar 

  • Freckleton, E., Sharpe, L., & Mullan, B. (2014). The relationship between maternal fear of hypoglycaemia and adherence in children with type-1 diabetes. International Journal of Behavioral Medicine, 21(5), 804–810.

    Article  PubMed  Google Scholar 

  • Gonder-Frederick, L., Nyer, M., Shepard, J. A., Vajda, K., & Clarke, W. (2011). Assessing fear of hypoglycemia in children with type 1 diabetes and their parents. Diabetes Management, 1(6), 627–639.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gonder-Frederick, L. A., Fisher, C. D., Ritterband, L. M., Cox, D. J., Hou, L., DasGupta, A. A., & Clarke, W. L. (2006). Predictors of fear of hypoglycemia in adolescents with type 1 diabetes and their parents. Pediatric Diabetes, 7(4), 215–222.

    Article  PubMed  Google Scholar 

  • Guthrie, D. W., Sargent, L., Speelman, D., & Parks, L. (1990). Effects of parental relaxation training on glycosylated hemoglobin of children with diabetes. Patient Education and Counseling, 16(3), 247–253.

    Article  CAS  PubMed  Google Scholar 

  • Hanson, C. L., De Guire, M. J., Schinkel, A. M., & Kolterman, O. G. (1995). Empirical validation for a family-centered model of care. Diabetes care, 18(10), 1347–1356.

    Article  CAS  PubMed  Google Scholar 

  • Haugstvedt, A., Wentzel-Larsen, T., Graue, M., Søvik, O., & Rokne, B. (2010). 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. Diabetic Medicine, 27(1), 72–78.

    Article  CAS  PubMed  Google Scholar 

  • Hawkes, C. P., McDarby, V., & Cody, D. (2014). Fear of hypoglycemia in parents of children with type 1 diabetes. Journal of Paediatrics and Child Health, 50(8), 639–642.

    Article  PubMed  Google Scholar 

  • Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis. New York: Guilford Publications, Inc.

    Google Scholar 

  • Irvine, A. A., Cox, D., & Gonder-Frederick, L. (1992). Fear of hypoglycemia: Relationship to physical and psychological symptoms in patients with insulin-dependent diabetes mellitus. Health Psychology, 11(2), 135–138.

    Article  CAS  PubMed  Google Scholar 

  • Irvine, A. A., Cox, D., & Gonder-Frederick, L. (1994). The fear of hypoglycaemia scale. In C. Bradley (Ed.), Handbook of psychology and diabetes: A guide to psychological measurement in diabetes research & practice (pp. 133–155). Hove: Psychology Press.

    Google Scholar 

  • Ly, T. T., Maahs, D. M., Rewers, A., Dunger, D., Oduwole, A., & Jones, T. W. (2014). Assessment and management of hypoglycemia in children and adolescents with diabetes. Pediatric Diabetes, 15(Suppl. 20), 180–192.

    Article  CAS  PubMed  Google Scholar 

  • Patterson, C. C., Dahlquist G. G., Gyürüs E., Green A., Soltész G., & the EURODIAB study group (2009). Incidence trends for childhood type 1 diabetes in Europe during 1989–2003 and predicted new cases 2005–2020: A multicentre prospective registration study. The Lancet, 373(9680), 2027–2033.

    Article  Google Scholar 

  • Patton, S. R., Dolan, L. M., Henry, R., & Powers, S. W. (2007). Parental fear of hypoglycemia: Young children treated with continuous subcutaneous insulin infusion. Pediatric Diabetes, 8(6), 362–368.

    Article  PubMed  Google Scholar 

  • Powers, S. W., Byars, K. C., Mitchell, M. J., Patton, S. R., Standiford, D. A., & Dolan, L. M. (2002). Parent report of mealtime behavior and parenting stress in young children with type 1 diabetes and in healthy control subjects. Diabetes care, 25(2), 313–318.

    Article  PubMed  Google Scholar 

  • Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments, & Computers, 36(4), 717–731.

    Article  Google Scholar 

  • Rewers, M. J., Pillay, K., de Beaufort, C., Craig, M. E., Hanas, R., Acerini, C. L., & Maahs, D. M. (2014). Assessment and monitoring of glycemic control in children and adolescents with diabetes. Pediatric Diabetes, 15(20), 102–114.

    Article  CAS  PubMed  Google Scholar 

  • Streisand, R., Braniecki, S., Tercyak, K. P., & Kazak, A. E. (2001). Childhood illness-related parenting stress: the pediatric inventory for parents. Journal of Pediatric Psychology, 26(3), 155–162.

  • Sweenie, R., Mackey, E. R., & Streisand, R. (2014). Parent–child relationships in type 1 diabetes: Associations among child behavior, parenting behavior, and pediatric parenting stress. Families, Systems, and Health, 32(1), 31–42.

    Article  PubMed  Google Scholar 

  • Wild, D., von Maltzahn, E., Brohan, E., Christensen, T., Clauson, P., & Gonder-Frederick, L. (2007). A critical review of the literature on fear of hypoglycemia in diabetes: Implications for diabetes management and patient education. Patient Education and Counseling, 68, 10–15.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to express our appreciation to the children and parents who participated in this study. Furthermore, we would like to thank the whole team of the Childhood Diabetes Centre for their assistance.

Author information

Author notes

  1. Ann-Sofie Viaene

    Present address: PraxisP, KU Leuven, Leopold Vanderkelenstraat 32, box 3764, 3000, Leuven, Belgium

Authors and Affiliations

  1. Department of Pediatric Diabetology and Endocrinology, Jessa Ziekenhuis, Hasselt, Belgium

    Ann-Sofie Viaene, Kelly Faust & Guy G. Massa

  2. Department of Applied Psychology, Thomas More University College, Antwerp, Belgium

    Tom Van Daele

  3. Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium

    Dries Bleys

Authors
  1. Ann-Sofie Viaene
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tom Van Daele
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dries Bleys
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kelly Faust
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Guy G. Massa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ann-Sofie Viaene.

Ethics declarations

Conflict of interest

Ann-Sofie Viaene, Tom Van Daele, Dries Bleys, Kelly Faust, and Guy G. Massa declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the ethics committee of the Jessa Ziekenhuis facility and with the 1964 Helsinki declaration, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Viaene, AS., Van Daele, T., Bleys, D. et al. Fear of Hypoglycemia, Parenting Stress, and Metabolic Control for Children with Type 1 Diabetes and Their Parents. J Clin Psychol Med Settings 24, 74–81 (2017). https://doi.org/10.1007/s10880-017-9489-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10880-017-9489-8

Keywords

Search

Navigation