Screening for Fear of Hypoglycemia in Type 1 Diabetes: Aligning Clinical Practice With Current Guidelines

OBJECTIVES: Recent clinical guidelines recommend screening for fear of hypoglycemia (FOH) as it is a known barrier in type 1 diabetes (T1D) management. Thus, this study proposes a one-item screening question to identify people living with T1D for whom FOH is a barrier to achieving glycemic targets and well-being. METHODS: Cross-sectional analysis using self-reported data from an online registry of people living with T1D. The one-item screening question "[Does] fear of hypoglycemia represent a barrier for you to achieve optimal blood sugar levels?" was validated by evaluating its association with glycemic outcomes (hemoglobin A1c [HbA1c]) and Hypoglycemia Fear Survey-II scores using regression models while adjusting for gender, hypoglycemia history, and hypoglycemia confidence. RESULTS: Among 1437 adults (mean age: 44.3 ± 15.1 years), 43% responded "yes" to the screening question (FOH + group). Participants in the FOH + group were more likely to self-identify as women, use medication to treat depression or anxiety, and report lower hypoglycemia confidence. The FOH + group had on average 0.48% [0.12, 0.83] higher HbA1c levels and were less likely to report reaching the recommended target HbA1c ≤ 7.0% (30% compared to 47%; P < .001). These associations remained significant even after adjusting for gender, hypoglycemia history, and hypoglycemia confidence. Hypoglycemia Fear Survey-II scores were significantly higher in the FOH + group (total score coefficient: 11.0 [9.1, 12.8]). CONCLUSIONS: As FOH remains under-assessed clinically, a validated one-item screening question can facilitate targeted and individualized clinical discussions for efficient recommendations and therapeutic adjustments.