569-P: Fear of Nighttime Hypoglycemia: Diabetes Providers Recognize Parents’ Concerns

Objective: Pediatric diabetes healthcare providers and parents of youth with type 1 diabetes (T1D) described specific fears regarding nighttime hypoglycemia and behaviors parents engage in at night to avoid nighttime lows (i.e., blood glucose < 70mg/dL).

Methods: We completed semi-structured interviews with 10 diabetes providers (i.e., physicians, nurses, educators) and 15 parents of youth with T1D (Mean parent age= 41.92 ± 5.72 years, Mean child age= 10.96 ± 2.37 years). All children used a continuous glucose monitor and 87% used an insulin pump. Providers described the fears and behaviors parents express in clinic related to their child’s overnight glucose management. Parents described their own fears and behaviors specific to nighttime lows. We transcribed interviews verbatim, and used Framework Matrix Analysis to identify common themes among responses.

Results: Provider and parent interviews converged on several main themes (provider percentages first, parent percentages second). Regarding specific fears, consensus among participants indicated that parents fear overnight lows will harm their child (i.e., death, seizures; 90%, 87%), parents worry they will not hear alarms or wake up to help their child at night (50%, 93%), and parents fear devices will malfunction at night (20%, 67%). Regarding avoidance behaviors, participants reported that parents provide snacks at bedtime to raise glucose levels (70%, 60%), parents set temporary (lower) basal levels (40%, 53%), under-correct at night 20%, 46%), set multiple alarms to wake up during the night to check on their child (80%, 87%), and do not allow their child to attend sleepovers (30%, 80%).

Conclusions: We identified several common fears and avoidance behaviors that may be specific to overnight lows in parents of youth with T1D. As a next step, we will use our qualitative data to inform a new tool to specifically assess parental fear of nighttime hypoglycemia, which will fill a current gap in both research and clinical care for youth with T1D.