title: Fear and other disturbances of severe hypoglycaemia in children and adolescents with type 1 diabetes mellitus.
abstract: OBJECTIVE
  To study perceived occurrence and magnitude of fear and other disturbances of severe hypoglycaemia in children and adolescents with type 1 diabetes mellitus (DM) receiving intensive treatment with active education and psychosocial support.
  
  
  METHODS
  Out of a geographic population of 112 patients <19 years of age and their families, with a DM duration >1 year, HbA1c mean+/-SD 6.7+/-0.9 (method 1.15% below DCCT level), 74 responded to a questionnaire. Visual analogue scales, 5-graded Likert scales and open questions were used.
  
  
  RESULTS
  Global quality of life was high, but lower among patients with severe hypoglycaemia within the last year (p = 0.0114). Worse perceived health was correlated to higher HbA1c year mean (r = 0.32, p = 0.0227). Patients and parents regard severe hypoglycaemia more as a problem (p <0.0001) and the risk of it more disturbing than mild hypoglycaemia (p <0.0001), insulin injections (p <0.0001) or blood glucose determinations (p <0.0001). The disturbance is higher during exercise, disco/party and in travel situations. Severe hypoglycaemia with unconsciousness causes more fear than severe hypoglycaemia needing assistance but without unconsciousness (p = 0.0001) or the potential late complications of DM (p = 0.0014). Severe hypoglycaemia needing assistance but without unconsciousness causes more fear than mild hypoglycaemia (p = 0.0001) and diabetic ketoacidosis (p <0.0001) but less than the potential late complications of DM (p = 0.0034).
  
  
  CONCLUSIONS
  Severe hypoglycaemia frequently causes fear and various disturbances in spite of active education and psychosocial support. There is a potential for increased quality of life from interventions targeted at the prevention of severe hypoglycaemia. Further research and improved strategies for the prevention of severe hypoglycaemia are needed.
authors.affiliation: Center for Medical Technology Assessment, Department of Health and Society, Linköping University, Linköping, Sweden. sam.nordfeldt@lio.se
authors.forename: Sam
authors.initials: S
authors.lastname: Nordfeldt
authors.forename: Johnny
authors.initials: J
authors.lastname: Ludvigsson
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000523:psychology*; D005239:Fear; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology* / Q000523:psychology*; D008297:Male; D010353:Patient Education as Topic; D011788:Quality of Life; D012307:Risk Factors; D012720:Severity of Illness Index; D012944:Social Support