Fear of hypoglycemia may lead to anxiety and depression in patients with type 1 diabetes

The study of 325 Egyptian patients with type 1 diabetes mellitus (T1DM) found that fear of hypoglycemia (FOH) may contribute to high anxiety and depression prevalence in this population. "Addressing and managing the different psychological diabetes aspects should be integrated within the routine diabetes management for T1DM patients," the researchers wrote.

The results showed that the prevalence of depressive symptoms in Egyptian patients with T1DM was 61.8%, and anxiety symptoms were 76.3%.

Patients with type 1 diabetes commonly face emotional problems such as depression, fear of hypoglycemia, and anxiety; their appropriate management could improve metabolic control and other health outcomes in those patients. The co-existence of depression and depression may form a vicious cycle; depression may impair proper blood sugar control and poor glycemic control, and its resulting complications worsen the depression symptoms.

Mohammed H. Zeitoun, Department of Internal Medicine, Alexandria University, Egypt, and colleagues aimed to determine the prevalence of anxiety and depressive symptoms among T1DM patients and their relation to diabetes complications, glycemic control, and fear of hypoglycemia in 325 patients with T1DM.

HADS (Hospital Anxiety and Depression Scale) was used to evaluate depressive and anxiety symptoms, and FOH was evaluated by Hypoglycemia Fear Survey II (HFS-II). A subsample comprising 75 patients was screened for diabetes complications. Fasting plasma glucose and HbA1c were used to assess glycemic control.

The study led to the following findings:

· The prevalence of FOH, depressive, and anxiety symptoms was 20%, 61.8%, and 76.3%, respectively.

· Female sex was related to depression but not anxiety.

· Logistic regression analysis revealed that HbA1c and HFS-II total scores were independently correlated with both anxiety symptoms and depressive symptoms.

· Age strongly correlated with HFS-II (total score) and Hypoglycemia Fear Survey-worry (HFS-W). In contrast, HbA1c showed an independent correlation with HFS-B (Hypoglycemia Fear Survey-behavior).

· Both depressive and anxiety symptoms were positively related to HFS-W score, HFS-B score, and HFS-II total score.

"Fear of hypoglycemia is common among Egyptian patients with type 1 diabetes, and it appears to be one of the factors contributing to the risen prevalence of depressive and anxiety symptoms among these individuals," the researchers wrote.

They conclude, "Addressing and managing the different psychological diabetes aspects should be incorporated within the routine diabetes care services for patients with type 1 diabetes."

Reference:

Zeitoun MH, Abdel Reheem AA, Kharboush IF, Sheshtawy H, Assad DH, El Feky AY. Relationship between depressive and anxiety symptoms and fear of hypoglycemia among adolescents and adults with type 1 diabetes mellitus. Prim Care Diabetes. 2023 Mar 14:S1751-9918(23)00039-6. doi: 10.1016/j.pcd.2023.03.002. Epub ahead of print. PMID: 36925404.