title: Investigating Hypoglycemic Confidence in Type 1 and Type 2 Diabetes.
abstract: While research designed to understand the concerns about hypoglycemia among patients with diabetes has been primarily focused on the investigation of fear and anxiety, recent evidence suggests a potentially important and conceptually distinct element-hypoglycemic confidence. To investigate this dimension, we developed the Hypoglycemic Confidence Scale (HCS); herein, we describe the construction and validation of the HCS and examine how key patient factors are associated with hypoglycemic confidence.
  
  
  
  Items were developed from interviews with six type 1 diabetes (T1D) adults, six insulin-using type 2 diabetes (T2D) adults, and seven diabetes healthcare professionals, resulting in nine self-report items. Separate exploratory factor analyses (EFAs) were conducted with T1D adults (N = 326), with T2D adults using both basal and prandial insulins (T2D-BP, N = 145) and with T2D adults using only basal insulin (T2D-BO, N = 82). Construct validity for the HCS was established with overall well-being (World Health Organization-5), diabetes distress (Diabetes Distress Scale), global anxiety (Generalized Anxiety Disorder), hypoglycemic fear (Hypoglycemic Fear Survey-II), and glycemic control (self-reported A1C). Hierarchical regression analyses examined the unique contribution of HCS scores, independent of hypoglycemic fear, on key psychosocial constructs and A1C.
  
  
  
  EFAs of the nine HCS items yielded a single factor solution for each of the three subject samples, accounting for 50.8%, 65.1%, and 73.7% of the variance for the T1D, T2D-BP, and T2D-BO groups, respectively. Construct validity was established by significant correlations with criterion variables. The HCS was associated with well-being and diabetes distress in the T1D (in both cases, P < 0.001) and T2D-BP groups (in both cases, P < .05) and for self-reported A1C in the T2D-BP group (P < .05) independent of hypoglycemic fear.
  
  
  
  Hypoglycemic confidence is a unique dimension of patient experience, different from hypoglycemic fear, and is deserving of further study. The HCS is a reliable valid measure of hypoglycemic confidence for adults with T1D and insulin-using T2D.
authors.affiliation: 1 Department of Psychiatry, University of California , San Diego, and Behavioral Diabetes Institute, San Diego, California.
authors.forename: William H
authors.initials: WH
authors.lastname: Polonsky
authors.affiliation: 2 Department of Family and Community Medicine, University of California , San Francisco, San Francisco, California.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Fisher
authors.affiliation: 2 Department of Family and Community Medicine, University of California , San Francisco, San Francisco, California.
authors.forename: Danielle
authors.initials: D
authors.lastname: Hessler
authors.affiliation: 3 Division of Endocrinology and Metabolism, University of California , San Diego, and Veterans Affairs Medical Center, San Diego, California.
authors.forename: Steven V
authors.initials: SV
authors.lastname: Edelman
mesh_terms: D000328:Adult; D000368:Aged; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000523:psychology*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000523:psychology*; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007328:Insulin / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Confidence; Hypoglycemia; Type 1 diabetes; Type 2 diabetes