Fear of Hypoglycemia: Psychological Associations and Diabetes Control in Youth with Type 1 Diabetes and Their Parents

Fear of hypoglycemia (FoH) is considered to be one of the major barriers to optimal control of type 1 diabetes (T1DM). Limited research in adults and adolescents suggests that both trait anxiety and experience of severe hypoglycemic episodes (SH) contribute to FoH; however, considerably less is known about this association in a wider age range of youth and their parents. Additionally, it is clinically accepted that FoH in youth and adults with TIDM is associated with poorer diabetes mellitus (DM) control. Nevertheless, this relationship has not been thoroughly explored for youths across a wide age range and their parents. This study investigated 1) the relationship between history of SHand trait anxiety and FoH and 2) the association between youth and parent FoH and youth DM control in a sample of 252 youth with T1DM (aged: 6-18) and 251 of their parents.

Hierarchical multiple regressions were used to assess what percent of variance history of SH and trait anxiety account for in F oH in youth and parents (separately). Results indicated that both frequency of SH and trait anxiety were associated with youth FoH. For parents, behavioral avoidance of hypoglycemia was higher for those with younger children, while parent worry was associated with parent trait anxiety but not with youth SH history.

The association between youth and parent FoH and DM control in youth was investigated with hierarchical multiple and logistic regression analyses using nine different outcome variables of DM control. Contrary to study hypotheses, DM control variables were not related to level of youth or parent FoH. To further explore these relationships, analyses of covariance were employed to investigate differences in DM control in both children and parents with extreme high and low scores on the HFS (4^th and 1^st quartiles, respectively). There was a significant difference in the expected direction between youth in the high and low quartiles on the Behavior Subscale for five outcome variables. Parents in the high quartile on the Worry Subscale had children with lower glycosylated hemoglobin (Ha1c). Possible explanations for findings were reviewed, providing directions for future research.