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. 2022 Sep 29;21(2):1689-1697.
doi: 10.1007/s40200-022-01123-y. eCollection 2022 Dec.

Potential mechanisms for poor glycaemic control in patients with type two diabetes and fear of hypoglycaemia

Ameera Mishal Alosaimi  1 , Nada Hamed Alsulaimani  2 , Wejdan Abdulraheem Alotaibi  2
Affiliations

Potential mechanisms for poor glycaemic control in patients with type two diabetes and fear of hypoglycaemia

Ameera Mishal Alosaimi et al. J Diabetes Metab Disord. .

Abstract

Purpose: The current study aimed to explore the potential effect of diabetes-related distress on the association between fear of hypoglycaemia and poor glycaemic control. We evaluated the specific aspects of fear of hypoglycaemia that affect glycaemic control among Saudi patients with type 2 diabetes (T2D).

Methods: Descriptive cross-sectional survey of patients with T2D attending a specialist diabetes clinic in Taif, Saudi Arabia. We used the Hypoglycaemia Attitudes and Behaviour Scale (HABS) for assessing fear of hypoglycaemia among our sample. We used Structural Equation Modelling to evaluate the moderators and correlates of fear of hypoglycaemia.

Results: We surveyed 365 patients with T2D. Cronbach's alpha for the HABS assessment was 0.84, an indication of excellent internal consistency. The composite reliability for hypoglycaemic anxiety was 86.8%; hypoglycaemic avoidance was 85.2%; and hypoglycaemic confidence was 92.6%. The mean HABS score was 32.7 points (out of 70 points; SD = 9.8 points). Fear of hypoglycaemia was associated with increased levels of glycated haemoglobin (HbA1c), presence of eye disease, heart disease, and stroke. Fear of hypoglycaemia was associated with poor glycaemic control. No significant moderating effect of diabetes-related distress was observed. However, only hypoglycaemic anxiety and avoidance were associated with poor glycaemic control. Confidence in the ability to control low glucose levels was not associated with elevated HbA1c levels.

Conclusion: A significant finding of this study highlighted the considerable and direct effect of fear of hypoglycaemia on poor glycaemic control among patients with T2D. However, only fear-related anxiety and avoidance-and not confidence in the ability to control low glucose levels-had an effect on poor glycaemic control.

Keywords: Diabetes Distress-17 scale; Diabetes type two; Fear of hypoglycaemia; Saudi Arabia; Taif.

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Conflict of interest statement

Competing interestsAuthors disclose no financial or non-financial interests that could be related to the current paper, either directly or indirectly.

Figures

Fig. 1
Fig. 1
Clinical factors with a significant effect on symptoms of fear of hypoglycaemia among the study participants. The data provided in Fig. 1 show that fear of hypoglycaemia was associated with increased HbA1c (odds = 1.033, p = 0.019), presence of eye disease (odds = 1.159, p < 0.001), heart disease (odds = 1.145, p = 0.003), stroke (odds = 1.274, p = 0.043). On the other hand, prescription of oral hypoglycaemic medications was associated with a lower fear of hypoglycaemia (odds = 0.929, p = 0.010), presence of retinopathy (odds = 0.872, p = 0.008), as did high BMI (odds = 0.995, p = 0.007) and high physical activity (odds = 0.911, p = 0.046)
Fig. 2
Fig. 2
Moderating effect of diabetes-related distress on the association between fear of hypoglycaemia and elevated HbA1c levels
Fig. 3
Fig. 3
Visual representation of the effects of HABS subscale domains on HbA1c values among the study participants
See this image and copyright information in PMC

References

    1. West C, McDowell J. The distress experienced by people with type 2 diabetes. Br J Community Nurs. 2002;7:606–613. doi: 10.12968/bjcn.2002.7.12.10901. - DOI - PubMed
    1. International Diabetes Federation. IDF Diabetes Atlas. 9th ed. Brussels, Belgium: International Diabetes Federation Publishing; 2019.
    1. Ogurtsova K, da Rocha Fernandes JD, Huang Y, et al. IDF diabetes atlas: global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract. 2017;128:40–50. doi: 10.1016/j.diabres.2017.03.024. - DOI - PubMed
    1. Zoungas S, Patel A, Chalmers J, et al. Severe hypoglycemia and risks of vascular events and death. New Engl J Med. 2010;363(15):1410–1418. doi: 10.1056/NEJMoa1003795. - DOI - PubMed
    1. Stahn A, Pistrosch F, Ganz X, Teige M, Koehler C, Bornstein S, Hanefeld M. Relationship between hypoglycemic episodes and ventricular arrhythmias in patients with type 2 diabetes and cardiovascular diseases: silent hypoglycemias and silent arrhythmias. Diabetes Care 2014 Feb;37(2):516–20. doi: 10.2337/dc13-0600. Epub 2013 Sep 16. - PubMed

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