title: Is hypoglycemia fear independently associated with health-related quality of life?
abstract: OBJECTIVE
  Patients may fear the symptoms and consequences associated with hypoglycemia. We tested whether fear of hypoglycemia is independently associated with poorer health-related quality of life (HRQOL).
  
  
  METHODS
  Data were collected using direct-mail survey and enrollment information from adult commercial health plan enrollees with type 2 diabetes during a 12-month period (12/01/2008 to 11/30/2009). HRQOL was evaluated by the EuroQol (EQ)-5D index and 12-item Short Form Health Survey Mental Component Summary (SF-12 MCS) and Physical Component Summary (SF-12 PCS). Fear of hypoglycemia was assessed using the Hypoglycemia Fear Survey (HFS). Two ordinary least-squares (OLS) models of HRQOL controlling for demographics and illness characteristics were specified, and OLS regression coefficients and statistical inferences were compared. Model 1 included 1 variable of hypoglycemia symptoms; Model 2 included both hypoglycemia symptoms and HFS score.
  
  
  RESULTS
  Of 3999 patients contacted, 813 responded to the survey. Model 1: hypoglycemia symptoms alone were associated with worse HRQOL (SF-12 MCS and SF-12 PCS scores and EQ-5D utility score; all P < 0.05). Model 2: hypoglycemia symptoms were significantly associated only with SF-12 MCS score. HFS total score was significantly associated with all 3 HRQOL scores. Hypoglycemia symptoms, Hispanic ethnicity, and longer diabetes duration were associated with greater hypoglycemia fear. Higher income, white race, and treatment without sulfonylurea or insulin were associated with less hypoglycemia fear (all P < 0.05).
  
  
  CONCLUSIONS
  In addition to the effect of symptomatic hypoglycemia on HRQOL, fear of hypoglycemia was independently associated with lower overall health status and mental and physical health.
authors.affiliation: Department of Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA. lshi1@tulane.edu.
authors.forename: Lizheng
authors.initials: L
authors.lastname: Shi
authors.affiliation: Department of Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA. hshao@tulane.edu.
authors.forename: Hui
authors.initials: H
authors.lastname: Shao
authors.affiliation: College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA. yzhao3@tulane.edu.
authors.forename: Yingnan
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: US Health Services Research, Bristol-Myers Squibb, Princeton, NJ, USA. nathomas@mac.com.
authors.forename: Nina A
authors.initials: NA
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology*; D005239:Fear; D005260:Female; D006304:Health Status; D006801:Humans; D007003:Hypoglycemia / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States