T. I. Ionova, V. I. Odin, T. P. Nikitina, K. A. Kurbatova

Fear of hypoglycemia in patients with 2 type diabetes mellitus receiving basal-bolus insulin therapy

Fear of hypoglycemia is one of the main psychological problems in patients with type 2 diabetes mellitus (DM2). Fear of hypoglycemia may lead to low treatment adherence and may contribute to serious disease complications. Till present there is a lack of literature data regarding fear of hypoglycemia in DM2 patients in Russia.

We aimed to assess fear of hypoglycemia in DM2 patients with or without hypoglycemia episodes during last month and to analyze the correlations between fear of hypoglycemia and quality of life (QoL). One thousand of DM2 patients who have been included in the observational program «Quality of life, symptoms of hypoglycemia and treatment satisfaction in patients with type 2 diabetes mellitus receiving basis-bolus insulin therapy» were enrolled in this study. Mean age – 61.1±8.5 years, 74% of patients – females, mean disease duration – 12.4 years (Mediana – 11.5 years). 90% of patients had late complications of DM2, 63.1% of patients experienced hypoglycemia during last month.

For analysis of fear of hypoglycemia we used the separate numeric rating scale (0-10) from Comprehensive Symptom Profile-Diabetes Mellitus-Hypoglycemia Module (CSP-DM-HypoGl). For QoL assessment the SF-36 was used. For means comparison with adjustment to gender, age and some clinical factors general linear model was used. Assessment of relations between means has been made using correlation analysis. It was shown that 72% of patients had no or had mild fear of hypoglycemia. 28% of patients had severe or critical fear of hypoglycemia.

There were less patients experienced fear of hypoglycemia among patients who had no hypoglycemia during last month as compared to patients who had hypoglycemia (46% vs 77%, p=0.001). Severity of fear of hypoglycemia was higher in patients who had hypoglycemia during last month as compared to patients without hypoglycemia (3.64 vs 1.36; p<0.001; ES=0.83).

There were more patients with severe fear of hypoglycemia among those who had severe or/and nocturnal hypoglycemia as compared to patients who had non-severe or had no hypoglycemia (27.3% vs 14.4% and 2.4%; р<0,001). It was shown, that the later episode of hypoglycemia the lower severity of fear of hypoglycemia. It was demonstrated, that the more severity of fear of hypoglycemia the more impairment of social functioning, mental health, vitality and general