Fear of hypoglycemia in adults with type 1 diabetes: impact of therapeutic advances and strategies for prevention - a review

J Diabetes Complications. 2016 Jan-Feb;30(1):167-77. doi: 10.1016/j.jdiacomp.2015.09.003. Epub 2015 Sep 7.


Purpose: This review summarizes the current state of the science related to fear of hypoglycemia (FOH) in adults with type 1 diabetes. Fear of hypoglycemia is a critical deterrent to diabetes self-management, psychological well-being, and quality of life. We examine the influence of contemporary treatment regimens, technology, and interventions to identify gaps in knowledge and opportunities for research and practice.

Basic procedures: A literature search was conducted of MEDLINE, PsycINFO, and EMBASE. Fifty-three studies that examined fear of hypoglycemia were included.

Main findings: Fear of hypoglycemia influences diabetes management and quality of life. Gender and age differences exist in experiences and responses. Responses vary from increased vigilance to potentially immobilizing distress. Fear of hypoglycemia is greater at night and may contribute to poor sleep quality. Strategies to reduce fear of hypoglycemia have had varying success. Newer technologies hold promise but require further examination.

Conclusions: Fear of hypoglycemia remains a problem, despite advances in technology, insulin analogs, and evidence-based diabetes management. Clinical care should consistently include assessment for its influence on diabetes self-management and psychological health. Further research is needed regarding the influence of newer technologies and individualized strategies to reduce fear of hypoglycemia while maintaining optimal glucose control.

Keywords: Adults; Fear; Hypoglycemia; Review; Type 1 diabetes.

Publication types

  • Review

MeSH terms

  • Adult
  • Anxiety / complications
  • Anxiety / etiology
  • Anxiety / prevention & control*
  • Attitude to Health
  • Combined Modality Therapy / adverse effects
  • Combined Modality Therapy / trends
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / drug therapy*
  • Diabetes Mellitus, Type 1 / psychology
  • Diabetes Mellitus, Type 1 / therapy
  • Humans
  • Hypoglycemia / chemically induced
  • Hypoglycemia / prevention & control*
  • Hypoglycemic Agents / adverse effects*
  • Hypoglycemic Agents / therapeutic use
  • Patient Compliance
  • Patient Education as Topic / trends
  • Precision Medicine* / trends
  • Quality of Life*
  • Self Care* / psychology
  • Self Care* / trends
  • Self Efficacy


  • Hypoglycemic Agents