Nighttime is the worst time: Parental fear of hypoglycemia in young children with type 1 diabetes

Pediatr Diabetes. 2018 Feb;19(1):114-120. doi: 10.1111/pedi.12525. Epub 2017 Apr 21.


Background: Fear of hypoglycemia is common in parents of young children with type 1 diabetes (T1D), but little is known about the specific fears that parents most often experience. Hypoglycemia fear has been associated with poorer glycemic control in older children, though not yet studied in a large cohort of very young children.

Materials and methods: Parents of 549 children <7 years (mean 5.2 ± 1.2 years [19% <3 years]) with a mean diabetes duration of 2.4 ± 1.0 years (range 1-6 years) and mean HbA1c 8.2% ± 1.1% (66 ± 12 mmol/mol) registered in the T1D Exchange completed the worry scale of the Hypoglycemia Fear Survey modified for parents (HFS-P).

Results: Mean parental fear of hypoglycemia worry score was 36.1 ± 23.1 (possible range 0-100), with most frequent worries related to the child having a low while asleep and the child not recognizing a low. The mean worry score was not associated with the child's age, glycemic control, or recent severe hypoglycemic event. Parental worries about lows while sleeping were significantly higher in pump users than non-users (61% vs. 45%; P < .001), and tended to be higher in CGM users than non-users (62% vs 51%; P = .02).

Conclusions: The greatest worries of parents of young children with T1D were related to hypoglycemia during sleep and other times/circumstances during which it would be difficult to detect hypoglycemia. Using advanced diabetes technologies may be an effort to temper fears about hypoglycemia during sleep, though the directionality of this relationship is undetermined. Additional studies can clarify this association and leverage use of diabetes technologies to improve glycemic control.

Keywords: T1D Exchange clinic registry; fear of hypoglycemia; type 1 diabetes; young children.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Child
  • Child, Preschool
  • Circadian Rhythm
  • Diabetes Mellitus, Type 1*
  • Fear*
  • Female
  • Humans
  • Hypoglycemia / chemically induced*
  • Hypoglycemic Agents / adverse effects
  • Insulin / adverse effects
  • Male
  • Parents / psychology*
  • Registries*


  • Hypoglycemic Agents
  • Insulin