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The aim of the present study was to assess determinants of fear of hypoglycemia (FOH) and its impact on diabetes self-management practices and glycemic control among adolescents with type 1 diabetes mellitus (T1DM). A cross-sectional study was conducted in four diabetes outpatient clinics. Adolescents with T1DM were included. The Hypoglycemia Fear Survey for Children (CHFS) and Diabetes Self-Management Questionnaire (DSMQ) were used. Glycosylated hemoglobin (HbA1c) records were obtained. Out of the 400 participants, 77.6% had suboptimal glycemic control (HbA1c > 7%). FOH was significantly higher among females, adolescents with suboptimal glycemic control, higher frequency of hypoglycemic episodes, and negative experiences with hypoglycemia (p ≤ 0.05). Among the DSMQ subscales, medication adherence had the best score, whereas dietary control had the lowest one. Female sex, older age group, late onset of T1DM, suboptimal glycemic control, hospitalization due to T1DM, and existence of co-morbidities were significantly associated with undesirable self-management practice (p ≤ 0.05). The total CHFS score was correlated positively with glucose monitoring (Pearson's correlation coefficient (r) = 0.104, p = 0.038), and negatively with health-care utilization (r = –0.140, p = 0.005). Hypoglycemia-avoidance behaviors were positively correlated with the DSMQ total score (r = 0.120, p = 0.016) and glucose monitoring (r = 0.201, p = 0.000). Hypoglycemia-related worries were negatively correlated with health-care utilization (r = –0.150, p = 0.003) and medication adherence (r = –0.115, p = 0.022). Developmentally appropriate diabetes education should target adolescents with diabetes based on their needs, worries, and concerns to alleviate FOH and improve self-management behaviors.
Fadl et al. (Sat,) studied this question.