title: Phobia of self-injecting and self-testing in insulin-treated diabetes patients: opportunities for screening.
abstract: OBJECTIVE
  To define clinically relevant cut-off points for severe fear of self-injecting (FSI) and self-testing (FST) (phobia) in insulin-treated patients with diabetes, and to estimate the magnitude of these phobias in our research population.
  
  
  METHODS
  FSI and FST were assessed in a cross-sectional survey using the Diabetes Fear of Injecting and Self-testing Questionnaire (D-FISQ). A sample of 24 insulin-treated adult diabetic patients was selected from the high-scorers on FSI and/or FST (> or = 95th percentile). FSI and FST were re-assessed, after which patients participated in a behavioural avoidance test (BAT), thereby determining the current level of avoidance of either self-injecting or self-testing. FSI and FST scores were linked to the outcome of the BATs. Cut-off scores for severe FSI/FST were determined and extrapolated to the total study population (n = 1275).
  
  
  RESULTS
  Seven patients participated in the self-injecting BAT: two patients refused to perform an extra injection. In the self-testing BAT (n = 17) four patients declined to perform the extra blood glucose self-test. Extrapolation of FSI and FST cut-off scores to the total research population showed that 0.2-1.3% of the population scored in the severe FSI range. In FST, 0.6-0.8% of the total study population obtained scores in the cut-off range.
  
  
  CONCLUSIONS
  Severe FSI and FST, characterized by emotional distress and avoidance behaviour, seems to occur in a small group of insulin-treated patients with diabetes. The D-FISQ can be of use to health care professionals (physicians, nurse specialists) in quickly providing valuable information on levels of FSI and FST in diabetes patients.
authors.affiliation: Institute for Research in Extramural Medicine (EMGO-Institute), Department of Medical Psychology, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands. ED.Mollema.EMGO@med.vu.nl
authors.forename: E D
authors.initials: ED
authors.lastname: Mollema
authors.forename: F J
authors.initials: FJ
authors.lastname: Snoek
authors.forename: R J
authors.initials: RJ
authors.lastname: Heine
authors.forename: H M
authors.initials: HM
authors.lastname: van der Ploeg
mesh_terms: D000328:Adult; D001362:Avoidance Learning; D015190:Blood Glucose Self-Monitoring / Q000523:psychology*; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000523:psychology*; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous / Q000523:psychology*; D008297:Male; D010698:Phobic Disorders / Q000209:etiology*; D012648:Self Care / Q000523:psychology; D011795:Surveys and Questionnaires