Fear of hypoglycemia: quantification, validation, and utilization

Cox, Daniel J; Irvine, Audrey; Gonder-Frederick, Linda; Nowacek, George; Butterfield, John

doi:10.2337/diacare.10.5.617

Cited by 580Diabetes Management and EducationDiabetes Management and ResearchAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Fear of hypoglycemia: quantification, validation, and utilization

Cox, Daniel J, Irvine, Audrey, Gonder-Frederick, Linda, Nowacek, George, Butterfield, John·1987·Diabetes Care

DOI 10.2337/diacare.10.5.617

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Abstract

Hypoglycemia can lead to various aversive symptomatic, affective, cognitive, physiological, and social consequences, which in turn can lead to the development of possible phobic avoidance behaviors associated with hypoglycemia. On the other hand, some patients may inappropriately deny or disregard warning signs of hypoglycemia. This study presents preliminary reliability and validity data on a psychometric instrument designed to quantify this fear: the hypoglycemic fear survey. The instrument was found to have internal consistency and test-retest stability, to covary with elevated glycosylated hemoglobin, and to be sensitive to a behavioral treatment program designed to increase awareness of hypoglycemia.

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Common diabetes-specific worries include fear of hyperglycemia, not meeting blood glucose targets, and insulin injections or infusion.
“Common diabetes-specific concerns include fears related to hyperglycemia (63,64), not meeting blood glucose targets (61), and insulin injections or infusion (65).”
From Psychosocial care for people with diabetes: a position statement of the American Diabetes Association (2016) · cites this paper as [63]
Fear of hypoglycemia may explain avoidance of behaviors associated with lowering glucose, such as increasing insulin doses or frequency of monitoring.
“A common diabetes-specific concern is fears related to hypoglycemia (375,376), which may explain avoidance of behaviors associated with lowering glucose, such as increasing insulin doses or frequency of monitoring.”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:Standards of Care in Diabetes—2023 (2023) · cites this paper as [375]

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“In addition to these unpleasant physical symptoms, negative moods, and threat of death, hypoglycemia can lead to socially and occupationally compromising situations secondary to associated cognitive motor dysfunctions (2,3).”
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Self-citation
3. Is the Fear of Hypoglycemia Associated with Glycemic Imbalance? (2213-PO)
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A critical review of the literature on fear of hypoglycemia in diabetes: implications for diabetes management and patient education
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Self-citation

Authors: Cox, D. J., Irvine, A., Gonder-Frederick, L., Nowacek, G., & Butterfield, J.
Affiliations: University of Cambridge (GB)
ORCID: Cox, Daniel J
Gonder-Frederick, Linda
Venue: Diabetes Care
Publisher: American Diabetes Association
Published: 1987-09-01
Volume: 10
Issue: 5
Pages: 617-621
ISSN: 0149-5992 (ISSN-L)
1935-5548
DOI: 10.2337/diacare.10.5.617
OpenAlex: W1983664900
Cited by: 579
References: 10
Citations by year: 2026: 15 · 2025: 20 · 2024: 31 · 2023: 42 · 2022: 32 · 2021: 20 · 2020: 41 · 2019: 22 · 2018: 21 · 2017: 32 · 2016: 22 · 2015: 22 · 2014: 28 · 2013: 22 · 2012: 16
FWCI: 2.40
Type: journal article
Language: en
Open access: closed
Locations: Diabetes Care (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (AM282880, AM24177)
National Center for Research Resources (M01RR000847, M01-RR 00847)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords: hypoglycemia, fear of hypoglycemia, psychometric validation, internal consistency, test-retest reliability, HbA1c, hypoglycemia awareness, diabetes mellitus
MeSH terms: Adolescent, Adult, Aged, Denial, Psychological, Diabetes Mellitus, Type 1, Fear, Humans, Hypoglycemia, Middle Aged, Surveys and Questionnaires

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Fear of hypoglycemia: quantification, validation, and utilization

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