2802-LB: Fear of Hypoglycemia in Caregivers of Pediatric Patients Living with Type 1 Diabetes: Associations with Glycemic Metrics and Clinical Characteristics?

Introduction and Objective: Fear of hypoglycemia (FOH) among caregivers of children living with type 1 diabetes (T1D) may drive compensatory behaviors such as tendency to maintain high blood glucose (MHBG). This study examined relationships between caregiver FOH, tendency to MHBG, and glycemic outcomes in a pediatric T1D cohort. Methods: Caregivers of children living with T1D completed the Hypoglycemia Fear Survey for parents (HFS-P), including subscales: FOH Behavior (10 items) and FOH Worry (15 items). The MHBG score was derived from 3 FOH Behavior items that assess MHBG behaviors. Glycemic data included A1C, Time in Range (TIR), 70-180 mg/dL, Time above Range (TAR) level 1, 181-250 mg/dL, TAR level 2, 250 mg/dL, Time Below Range (TBR) level 1, 54-69 mg/dL, and TBR level 2, 54 mg/dL. Spearman correlations assessed FOH glycemic relationships. Independent t-tests and Cohen's d compared outcomes across subgroups. Results: The cohort's (N=50) mean A1C was 7.19% (SD 0.97, Median 6.9), TIR was 65.8% (Median 68), and FOH Total was 37.54 (Median 35). FOH Behavior correlated significantly with TAR level 1 (ρ = 0.325, p = 0.021), not A1C. Combined TBR level 1 and 2 (70 mg/dL) was strongly correlated with A1C (ρ = −0.494, p 0.001), not FOH Behavior (ρ = −0.021, p = 0.887) or MHBG (ρ = −0.064, p = 0.657). Patients with MHBG ≥6 had lower TBR level 2 (Median 0 vs 0.4, p 0.001, d = −1.49), trended toward higher TAR level 1 (d = 1.02, p = 0.095), and showed reduced combined TBR level 1 and 2 (d = −0.68, p = 0.136). Conclusion: This study found FOH Behavior correlated with TAR, and a tendency to MHBG effectively prevented hypoglycemia at the cost of increased hyperglycemia. Combined TBR correlated with A1C but not FOH or MHBG, suggesting caregiver fear may reflect a fear of severe hypoglycemia, not overall hypoglycemia burden. These findings support integrating FOH screening into pediatric T1D care to identify families whose fear-driven management may benefit from targeted education and psychosocial support. Disclosure J. Ilkowitz: None. A. Shah: None. P.T. Burns: None. M. Gallagher: Research Support; Current; BioMarin Pharmaceutical Inc., T1D Exchange, IQVIA Inc., MannKind Corporation, National Institute of Diabetes and Digestive and Kidney Diseases, Sanofi-Aventis U.S., Diamyd. C.R. Stein: None.