Psychosocial Aspects


Manon Coolen, Jori Aalders, Melanie Broadley, Henk-Jan Aanstoot, Esther Hartman, Christel Hendrieckx, Giesje Nefs, Frans Pouwer

Hypoglycaemia and diabetes-specific quality of life in adolescents with type 1 diabetes. Diabet Med . 2021 Aug;38(8):e14565.

Despite many improvements in diabetes care, hypoglycemia is still a major problem for young people with diabetes. Puberty-related physiological and psychological changes add to existing challenges of dealing with type 1 diabetes. Diabetes care strives to find a balance between diabetes management and quality of life (QoL). QoL is difficult to measure due to its dynamic, subjective and multi-dimensional nature. It has been shown that hypoglycemia can have long-lasting emotional impact, although less is known about the role of hypoglycemia in relation to diabetes-specific QoL in type 1 diabetes. Worries about and fear of hypoglycemia may lead to compromised disease management (e.g. avoidance behaviour). Earlier studies did not assess frequency, perceived severity and fear of hypoglycemia simultaneously.


This study aimed to assess if perceived severity and fear of hypoglycemia have additional value over frequency of hypoglycemia, in explaining diabetes-specific QoL in adolescents with type 1 diabetes.

In this cross-sectional study, part of the ‘Whose diabetes is it anyway?’ project, self-reported data were obtained on demographics, frequency and perceived severity of both self-treated and severe hypoglycaemia, fear of hypoglycaemia (HFS-C) and diabetes-specific quality of life (PedsQL-DM). Hierarchical regression analyses were performed; independent variables were entered in the following steps: (1) age, gender and HbA1c, (2) frequency of hypoglycaemia, (3) perceived severity of hypoglycaemia and (4) fear of hypoglycaemia.


Key findings:

  • 96 Adolescents (12–18 years) completed questionnaires.
  • In the first three steps, female gender, higher HbA1c, higher frequency of severe hypoglycaemia and higher perceived severity of severe and self-treated hypoglycaemia were significantly associated with lower diabetes-specific QoL
  • However, in the final model only fear of hypoglycaemia was significantly associated with QoL (p < 0.001)
  • Adolescents with greater fear reported lower diabetes-specific QoL (observed across subdomains of diabetes-specific quality of life)


Concluding, the authors state

"This has important implications for clinical practice; future studies are needed to identify if reduction of fear of hypoglycaemia is associated with an improvement of diabetes-specific QoL in adolescents with type 1 diabetes" -

Please click here for this publication in PubMed.

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