Fear of hypoglycemia (FoH) has been associated with suboptimal diabetes management and health outcomes. The American Diabetes Association recommends further mental health evaluation and treatment if a person with diabetes has a positive screen for FoH. This study investigated factors associated with behavioral and emotional aspects of FoH among adults living with T1D. The study included 494 participants from T1D Exchange Glu (mean [SD] age 43.9 ± 12.2 years, duration of T1D 16.6 ± 16.8 years, self-reported A1c 6.9 ± 0.8%), 63% male, 89% on insulin pump, 25% experienced a severe hypoglycemic event in the last six months. The Hypoglycemia Fear Scale (HFS-II) short form and the Hypoglycemia Attitudes and Behavior Scale (HABS) were used to assess FoH. Multivariable regression analyses showed that higher anxiety, higher depression, and higher diabetes distress were associated with FoH (Table 1). Longer duration of diabetes was associated with lower FoH. Ever experienced severe low blood glucose was associated with higher worry of hypoglycemia but not avoidance behavior. Higher avoidance behavior but not worry/anxiety of hypoglycemia was associated with higher A1c or more diabetes-related comorbidities. These results highlighted the multifaceted nature of FoH and suggest that positive screen for anxiety, depression, or diabetes distress warrants further discussion on FoH between providers and patients with T1D.


J. Liu: None. B. Mitchell: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. J. Bispham: None. L. Fan: Employee; Self; Lilly Diabetes. Stock/Shareholder; Self; Lilly Diabetes. A. Hughes: None. A. McAuliffe-Fogarty: None.

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