title: Fear of hypoglycemia: relationship to hypoglycemic risk and psychological factors.
abstract: OBJECTIVE
  The major aims of this study were to examine (1) the association between fear of hypoglycemia (FOH) in adults with type 1 diabetes with demographic, psychological (anxiety and depression), and disease-specific clinical factors (hypoglycemia history and unawareness, A1c), including severe hypoglycemia (SH), and (2) differences in patient subgroups categorized by level of FOH and risk of SH.
  
  
  METHODS
  Questionnaires were mailed to 764 patients with type 1 diabetes including the Swedish translation of the Hypoglycemia Fear Survey (HFS) and other psychological measures including the Perceived Stress Scale, Hospital Anxiety and Depression Scale, Anxiety Sensitivity Index, Social Phobia Scale, and Fear of Complications Scale. A questionnaire to assess hypoglycemia history was also included and A1c measures were obtained from medical records. Statistical analyses included univariate approaches, multiple stepwise linear regressions, Chi-square t tests, and ANOVAs.
  
  
  RESULTS
  Regressions showed that several clinical factors (SH history, frequency of nocturnal hypoglycemia, self-monitoring) were significantly associated with FOH but R (2) increased from 16.25 to 39.2 % when anxiety measures were added to the model. When patients were categorized by level of FOH (low, high) and SH risk (low, high), subgroups showed significant differences in non-diabetes-related anxiety, hypoglycemia history, self-monitoring, and glycemic control.
  
  
  CONCLUSIONS
  There is a strong link between FOH and non-diabetes-related anxiety, as well as hypoglycemia history. Comparison of patient subgroups categorized according to level of FOH and SH risk demonstrated the complexity of FOH and identified important differences in psychological and clinical variables, which have implications for clinical interventions.
authors.affiliation: Department of Psychology, Stockholm University, 106 91, Stockholm, Sweden, therese.anderbro@psychology.su.se.
authors.forename: Therese
authors.initials: T
authors.lastname: Anderbro
authors.forename: Linda
authors.initials: L
authors.lastname: Gonder-Frederick
authors.forename: Jan
authors.initials: J
authors.lastname: Bolinder
authors.forename: Per-Eric
authors.initials: PE
authors.lastname: Lins
authors.forename: Regina
authors.initials: R
authors.lastname: Wredling
authors.forename: Erik
authors.initials: E
authors.lastname: Moberg
authors.forename: Jan
authors.initials: J
authors.lastname: Lisspers
authors.forename: Unn-Britt
authors.initials: UB
authors.lastname: Johansson
mesh_terms: D000328:Adult; D001007:Anxiety; D001786:Blood Glucose / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000378:metabolism / Q000523:psychology*; D005239:Fear; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000378:metabolism / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires
chemical_list: D001786:Blood Glucose