title: Multivariate models of health-related utility and the fear of hypoglycaemia in people with diabetes.
abstract: OBJECTIVE
  The aim was to statistically model the degree of fear of hypoglycaemia experienced by people with diabetes, and then model the resulting change in health-related utility associated with differing severity and frequency of hypoglycaemia.
  
  
  METHODS
  The study used pooled data from two previous postal surveys among subjects with confirmed diabetes conducted in Cardiff, UK (n = 1305 responses). The fear of hypoglycaemia was characterised using the Hypoglycaemia Fear Survey (HFS [eight question worry sub-scale only]), and health-related utility using the EQ5D(index). The data were then analysed using univariate and multivariate analysis.
  
  
  RESULTS
  Following detailed preliminary analysis, a two-stage approach was used since fear was important when estimating the EQ5D(index). Fear was then modelled as a function of the severity and frequency of hypoglycaemia while controlling for other factors such as diabetes-related complications. Each severe hypoglycaemic event resulted in a change of 5.881 units on the HFS. One or more symptomatic hypoglycaemic events over the same period results in a corresponding change of 1.773 units on the HFS. A 1 unit increase on the HFS results in a 0.008 unit decrease on the EQ5D(index).
  
  
  CONCLUSIONS
  While controlling for other factors, the fear of hypoglycaemia was an important determinant of health-related utility. The magnitude of fear of hypoglycaemia was associated with the severity and frequency of hypoglycaemia. Hypoglycaemia was associated with a considerable decrement in health-related utility as a function of increased fear. Measures should be taken to minimise the severity and frequency of hypoglycaemia.
authors.affiliation: Department of Medicine, School of Medicine, Cardiff University, Cardiff, UK.
authors.forename: Craig J
authors.initials: CJ
authors.lastname: Currie
authors.forename: Christopher Ll
authors.initials: CL
authors.lastname: Morgan
authors.forename: Chris D
authors.initials: CD
authors.lastname: Poole
authors.forename: Peter
authors.initials: P
authors.lastname: Sharplin
authors.forename: Morten
authors.initials: M
authors.lastname: Lammert
authors.forename: Phil
authors.initials: P
authors.lastname: McEwan
mesh_terms: D000328:Adult; D000368:Aged; D003625:Data Collection; D048909:Diabetes Complications / Q000453:epidemiology / Q000523:psychology; D003920:Diabetes Mellitus / Q000523:psychology*; D005239:Fear; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006304:Health Status; D006801:Humans; D007003:Hypoglycemia / Q000150:complications* / Q000453:epidemiology / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D015999:Multivariate Analysis; D015995:Prevalence; D012720:Severity of Illness Index
chemical_list: D006442:Glycated Hemoglobin