title: Fear of needles in children with type 1 diabetes mellitus on multiple daily injections and continuous subcutaneous insulin infusion.
abstract: OBJECTIVE
  To assess the prevalence of fear of needles and its effect on glycemic control in children with type 1 diabetes mellitus (T1DM) on multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII).
  
  
  METHODS
  Patients aged 6 to 17 years with T1DM on MDI or CSII (n = 150) were enrolled. All caregivers and patients aged ≥11 years completed a "Diabetes Fear of Injecting and Self-testing Questionnaire" (D-FISQ). Needle phobia was defined as a score ≥6 for fear of self-testing (FST), fear of injections (FI), and fear of infusion-site changes (FISC).
  
  
  RESULTS
  Positive FST scores were noted in 10.0% and positive FI or FISC scores in 32.7% (caregivers' responses). Patients aged 6 to 10 years on CSII had greater fear (FISC) than those on MDI (FI) (P = .010). FST was inversely related to the number of daily blood sugar checks (P = .003). Patients with positive scores for FI/FISC or FST had significantly higher glycated hemoglobin (HbA1c) levels than those without. An inverse association was noted between positive FI/FISC scores and age of the patient (P = .029). Based on patient responses, FST severity was directly related to the age of the patient (P = .013).
  
  
  CONCLUSIONS
  Needle phobia is common in children with T1DM. Although FI/FISC are more common in younger children, especially in those on CSII, FST is more often encountered in older patients. Patients with a more intense fear of needles have higher HbA1c levels and less frequent blood sugar monitoring. Identifying these patients may help improve glycemic control.
authors.affiliation: Spectrum Health Medical Group, Pediatric Endocrinology, Helen DeVos Children's Hospital, Grand Rapids, Michigan Michigan State University, Grand Rapids, Michigan.
authors.forename: Ayse Pinar
authors.initials: AP
authors.lastname: Cemeroglu
authors.affiliation: Michigan State University, Grand Rapids, Michigan.
authors.forename: Argun
authors.initials: A
authors.lastname: Can
authors.affiliation: Grand Rapids Medical Education Partners (GRMEP), Grand Rapids, Michigan Department of Surgery, Michigan State University, Grand Rapids, Michigan.
authors.forename: Alan T
authors.initials: AT
authors.lastname: Davis
authors.affiliation: Department of Physical Medicine and Rehabilitation, Turgut Ozal University School of Medicine, Ankara, Turkey.
authors.forename: Ozlem
authors.initials: O
authors.lastname: Cemeroglu
authors.affiliation: Spectrum Health Medical Group, Pediatric Endocrinology, Helen DeVos Children's Hospital, Grand Rapids, Michigan.
authors.forename: Lora
authors.initials: L
authors.lastname: Kleis
authors.affiliation: Spectrum Health Medical Group, Pediatric Endocrinology, Helen DeVos Children's Hospital, Grand Rapids, Michigan Michigan State University, Grand Rapids, Michigan.
authors.forename: Maala S
authors.initials: MS
authors.lastname: Daniel
authors.affiliation: Spectrum Health Medical Group, Pediatric Endocrinology, Helen DeVos Children's Hospital, Grand Rapids, Michigan.
authors.forename: Jessica
authors.initials: J
authors.lastname: Bustraan
authors.affiliation: Grand Rapids Medical Education Partners (GRMEP), Grand Rapids, Michigan.
authors.forename: Tracy J
authors.initials: TJ
authors.lastname: Koehler
mesh_terms: D000293:Adolescent; D015190:Blood Glucose Self-Monitoring; D002648:Child; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D005239:Fear; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007279:Injections, Subcutaneous; D007328:Insulin / Q000627:therapeutic use*; D007332:Insulin Infusion Systems; D009339:Needles; D011446:Prospective Studies
chemical_list: D006442:Glycated Hemoglobin; D007328:Insulin; C517652:hemoglobin A1c protein, human