The proposed project is a response to PA-06-151 for secondary data analysis, and will take advantage of a unique set of previously collected data from NIH-funded studies conducted at the University of Virginia (n = >2500) and other studies around the world (n >3500) to conduct an in-depth investigation into the Hypoglycemia Fear Survey (HFS) and fear of hypoglycemia (FOH). In diabetes, hypoglycemia can be associated with numerous negative consequences ranging from unpleasant symptoms and social embarrassment to physical injury and even life-threatening situations. For this reason, FOH is considered one of the major psychological barriers to achieving optimal glucose control. Thus, it is critical to study FOH scientifically, understand its impact on quality of life and diabetes control, and reduce its potential negative effect on people living with diabetes. To do this, there must be a way to quantify, or measure, this diabetes-specific form of anxiety. The HFS is a 33-item questionnaire, specifically designed by our research group to measure 1) worry about hypoglycemia and its negative consequences and 2) behaviors to avoid hypoglycemia and its potential effects. The original HFS was designed to measure FOH in adults with type 1 diabetes, but versions were subsequently developed for children with type 1 diabetes, adults with type 2 diabetes, and patients'family members, who may also experience FOH. The HFS has also been translated into at least 12 languages and used in diabetes research in at least 16 different countries, often as an outcome measure in clinical trials of behavioral interventions, diabetes medications, and newly emerging treatments and technologies, including islet cell transplants and continuous glucose sensors. In spite of its widespread utility and use, little is known about the psychometric properties of the HFS, so there is no empirical basis for interpretation of scores or comparisons across patient groups and cultures. The proposed project will create a large, international data set and provide the much-needed opportunity to generate normative HFS data for different patient subgroups, assess the reliability and validity of the HFS, and begin to examine differences in FOH across cultures and global regions. A HypoFear Web portal site will then be developed in order to provide easy access to these psychometric findings to the scientific community and promote empirically-based interpretation of the HFS. This will be an invaluable resource for diabetes researchers and also facilitate the use of the HFS in clinical settings to identify patients with problematic FOH. In addition, the proposed project will take advantage of the unprecedented opportunity provided by these large data sets to explore a number of important hypotheses regarding the development of FOH, and its impact on quality of life, diabetes management, and medical outcome for people living with diabetes.

Public Health Relevance

In people with diabetes, fear of hypoglycemia (FOH) can have a significant negative impact on quality of life and medical outcome, and therefore it is important to study FOH scientifically. The most commonly used measure of FOH around the globe is the Hypoglycemia Fear Survey (HFS), but little is known about what constitutes normal levels of fear in different patient groups, or the reliability and validity of the survey, and this is a major barrier to understanding FOH and how to reduce it. By gathering and analyzing large pre-existing sets of HFS data (over 6,000 surveys from around the world), this project provides a unique opportunity to answer important questions about the HFS and FOH, create a website to provide the diabetes research community with information they need to study FOH, and help people with diabetes reduce the negative impact of FOH on their lives.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Exploratory/Developmental Grants (R21)
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Study Section
Kidney, Nutrition, Obesity and Diabetes (KNOD)
Program Officer
Hunter, Christine
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University of Virginia
Schools of Medicine
United States
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Shepard, Jaclyn A; Vajda, Karen; Nyer, Maren et al. (2014) Understanding the construct of fear of hypoglycemia in pediatric type 1 diabetes. J Pediatr Psychol 39:1115-25
Gonder-Frederick, L A; Vajda, K A; Schmidt, K M et al. (2013) Examining the Behaviour subscale of the Hypoglycaemia Fear Survey: an international study. Diabet Med 30:603-9
Gonder-Frederick, Linda; Shepard, Jaclyn; Peterson, Ninoska (2011) Closed-loop glucose control: psychological and behavioral considerations. J Diabetes Sci Technol 5:1387-95
Gonder-Frederick, Linda; Nyer, Maren; Shepard, Jaclyn A et al. (2011) Assessing fear of hypoglycemia in children with Type 1 diabetes and their parents. Diabetes Manag (Lond) 1:627-639
Gonder-Frederick, Linda A; Schmidt, Karen M; Vajda, Karen A et al. (2011) Psychometric properties of the hypoglycemia fear survey-ii for adults with type 1 diabetes. Diabetes Care 34:801-6