Identifying the worries and concerns about hypoglycemia in adults with type 2 diabetes

J Diabetes Complications. 2015 Nov-Dec;29(8):1171-6. doi: 10.1016/j.jdiacomp.2015.08.002. Epub 2015 Aug 7.


Aims: To identify the hypoglycemic concerns of adults with type 2 diabetes (T2D) and examine how these concerns are associated with key patient characteristics.

Methods: Qualitative interviews with 16 T2D adults and 11 diabetes care providers were conducted. Survey items were then developed and submitted to exploratory factor analyses (EFAs). Construct validity was assessed by correlations with diabetes distress, anxiety and depressive symptoms, well-being, hypoglycemic fear, hypoglycemia history and glycemic control (A1C).

Results: An EFA with 226 insulin users and 198 non-insulin users yielded 3 factors (14 items): Hypoglycemia Anxiety, Avoidance and Confidence. For both T2D groups, higher Anxiety and Avoidance were significantly associated with more hypoglycemia, lower well-being, and greater diabetes distress, depressive symptoms and hypoglycemic fear. Similar associations, in the converse direction, were found for Confidence. Among insulin users only, Anxiety was independently associated with greater emotional distress and more hypoglycemia, while Confidence was independently linked to less emotional distress and lower A1C. Avoidance was independently associated with greater emotional distress in both groups.

Conclusions: Using the new 14-item Hypoglycemic Attitudes and Behavior Scale (HABS), we found that hypoglycemic concerns are significant in T2D adults, are linked to emotional distress and A1C, and merit attention in clinical practice.

Keywords: Avoidance; Distress; Fear; Hypoglycemia; Type 2 diabetes; Worry.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Aged
  • Anxiety / complications*
  • Attitude of Health Personnel
  • Attitude to Health*
  • California
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / drug therapy
  • Diabetes Mellitus, Type 2 / psychology*
  • Factor Analysis, Statistical
  • Fear
  • Female
  • Glycated Hemoglobin / analysis
  • Humans
  • Hypoglycemia / chemically induced*
  • Hypoglycemia / prevention & control
  • Hypoglycemic Agents / adverse effects*
  • Hypoglycemic Agents / therapeutic use
  • Insulin / adverse effects*
  • Insulin / therapeutic use
  • Internet
  • Male
  • Middle Aged
  • Psychiatric Status Rating Scales
  • Qualitative Research
  • Registries
  • Self Report
  • Stress, Psychological / complications*


  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • Insulin
  • hemoglobin A1c protein, human