Is hypoglycemia fear independently associated with health-related quality of life?

Abstract

Objective: Patients may fear the symptoms and consequences associated with hypoglycemia. We tested whether fear of hypoglycemia is independently associated with poorer health-related quality of life (HRQOL).

Research design and methods: Data were collected using direct-mail survey and enrollment information from adult commercial health plan enrollees with type 2 diabetes during a 12-month period (12/01/2008 to 11/30/2009). HRQOL was evaluated by the EuroQol (EQ)-5D index and 12-item Short Form Health Survey Mental Component Summary (SF-12 MCS) and Physical Component Summary (SF-12 PCS). Fear of hypoglycemia was assessed using the Hypoglycemia Fear Survey (HFS). Two ordinary least-squares (OLS) models of HRQOL controlling for demographics and illness characteristics were specified, and OLS regression coefficients and statistical inferences were compared. Model 1 included 1 variable of hypoglycemia symptoms; Model 2 included both hypoglycemia symptoms and HFS score.

Results: Of 3999 patients contacted, 813 responded to the survey. Model 1: hypoglycemia symptoms alone were associated with worse HRQOL (SF-12 MCS and SF-12 PCS scores and EQ-5D utility score; all P < 0.05). Model 2: hypoglycemia symptoms were significantly associated only with SF-12 MCS score. HFS total score was significantly associated with all 3 HRQOL scores. Hypoglycemia symptoms, Hispanic ethnicity, and longer diabetes duration were associated with greater hypoglycemia fear. Higher income, white race, and treatment without sulfonylurea or insulin were associated with less hypoglycemia fear (all P < 0.05).

Conclusions: In addition to the effect of symptomatic hypoglycemia on HRQOL, fear of hypoglycemia was independently associated with lower overall health status and mental and physical health.

Figure 1

Comparison of health-related quality-of-life scores and fear of hypoglycemia between patients who reported (n = 235) vs those who did not report (n = 578) symptoms of hypoglycemia. EQ-5D=EuroQol-5D scale; HFS = Hypoglycemia Fear Survey; MCS = Mental Component Summary; PCS = Physical Component Summary; SF-12 = 12-item Short Form Health Survey. *P < 0.0001, ^† P = 0.0007 by t test.