Introduction & Objective: Fear of hypoglycemia (FoH) is linked to diminished diabetes clinical and psychosocial outcomes; yet its real-world burden in the United States remains poorly quantified. We analyzed iNPHORM data to address this gap.
Methods: Adults (≥18 years old) with T1DM or T2DM on insulin and/or secretagogues were recruited from a US-wide, probability-based internet panel. Online screening, baseline, and 12-month follow-up questionnaires (FQ) captured data prospectively. We measured FoH at FQ Month 6 using the Hypoglycemia Fear Survey II, which comprises Worry and Behaviour subscales. Per assessment guidelines, we calculated absolute total and subscale-specific FoH scores, and prevalences of elevated versus non-elevated scores, overall and by diabetes type. Wilcoxon rank-sum tests and Z-tests assessed differences in T1DM and T2DM responses (α=0.05).
Results: N=781 were analyzed (T1DM: 18.4%; age: 51.2 [SD: 14.6] years; male: 50.7%; retention rate: 64.8%). All T1DM respondents used insulin; among those with T2DM, 40.2% used insulin without secretagogues, 36.7% used secretagogues without insulin, and 23.1% used both. Median absolute FoH Worry and Behaviour subscale scores were 30 [IQR: 21] and 29 [IQR: 18], respectively. For both subscales, absolute scores were higher in T1DM than T2DM (Worry subscale: 35 [T1DM] vs. 29 [T2DM], p=0.003; Behaviour subscale: 32.5 [T1DM] vs. 28 [T2DM], p<0.001). The overall prevalence of elevated FoH was 16.3% (T1DM: 19.4%; T2DM: 15.5%, p-value=0.25). For Worry and Behaviour subscales, 15.0% (T1DM: 14.6%; T2DM: 15.1, p-value=0.88) and 16.3% (T1DM: 17.4%; T2DM: 16.0%, p-value=0.69) reported elevated scores, respectively.
Conclusion: Despite greater absolute FoH scores in T1DM, we observed no significant differences in elevated FoH prevalences by diabetes type. Our results underscore the high and ubiquitous burden of FoH in diabetes. Clinical interventions should target not only people with T1DM but also T2DM, including those on secretagogues without insulin.
A. Ratzki-Leewing: Research Support; Sanofi. Advisory Panel; Dexcom, Inc. Consultant; Abbott. Advisory Panel; Sanofi-Aventis U.S. Other Relationship; American Diabetes Association. Consultant; Novo Nordisk, Eli Lilly and Company. J.E. Black: None. G. Zou: None. B.L. Ryan: None. S.B. Harris: Consultant; Abbott. Research Support; Boehringer-Ingelheim. Consultant; Dexcom, Inc. Advisory Panel; Eli Lilly and Company. Consultant; Eli Lilly and Company, Novo Nordisk, Sanofi. Research Support; Novartis AG. Consultant; Bayer Inc.
The iNPHORM study was funded through an investigator-initiated grant from Sanofi Global.
