ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Clinical Diabetes
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1563410
This article is part of the Research TopicThe Need for an Integrative Approach in Type 1 Diabetes ManagementView all articles
Fear of Hypoglycemia Is Linked to Poorer Glycemic Control and Reduced Quality of Life in Adults with Type 1 Diabetes
Provisionally accepted
Manuel Ángel Mesa Díaz
Samuel Belmonte
Pablo Rodríguez De Vera Gómez*María Victoria Llanes GonzálezCarmen Mateo RodríguezLucía Hidalgo SoteloMaría Asunción Martínez-Brocca*- Virgen Macarena University Hospital, Seville, Spain
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Aim:Analyze the influence of Fear of Hypoglycemia (FoH) on quality of life and glycemic control in adults with Type 1 Diabetes Mellitus (T1D) who use Flash Glucose Monitoring (FGM)Methods:A cross-sectional study was conducted with 173 adults with T1D. FoH was assessed using the FH15 questionnaire, and quality of life was evaluated using the Spanish Diabetes Quality of Life questionnaire (EsDQOL). Glycemic control was analyzed through FGM-derived metrics (Ambulatory Glucose Profile) and HbA1c. Multivariate multiple linear regression models were developed to analyze the adjusted impact of FoH on quality of life and time in hyperglycemia.Results:FoH was present in 42% of participants (FH15 ≥28). Patients with FoH exhibited significantly higher EsDQOL scores, reflecting poorer quality of life, and higher HbA1c levels (7.41% vs. 7.08%, p=0.012). FGM metrics revealed higher mean glucose, glucose management indicator (GMI) (p=0.008), and time in hyperglycemia >250 mg/dL (p=0.035) in the FoH group, with lower time in range 70–180 mg/dl (p=0.035). Hypoglycemia unawareness was more frequent in the FoH group (25.4% vs. 6.5%, p=0.011). The FH15 score functioned as an independent predictor of quality of life (β = 1.98 [1.58; 2.37]) and time in hyperglycemia (β = 0.39 [0.17; 0.61]) in the multiple linear regression models.Conclusion:FoH is significantly associated with poor quality of life and worsened glycemic control in T1D patients, underscoring the need for systematic assessment and individualized interventions. FGM metrics, particularly time in hyperglycemia, may serve as valuable predictors of FoH. Comprehensive management strategies addressing both metabolic and psychological factors are essential for improving patient outcomes.
Keywords: type 1 diabetes, Quality of Life, Fear of hypoglycemia, flash glucose monitoring, ambulatory glucose profile
Received: 19 Jan 2025; Accepted: 28 Apr 2025.
Copyright: © 2025 Mesa Díaz, Belmonte, Rodríguez De Vera Gómez, Llanes González, Mateo Rodríguez, Hidalgo Sotelo and Martínez-Brocca. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Pablo Rodríguez De Vera Gómez, Virgen Macarena University Hospital, Seville, Spain
María Asunción Martínez-Brocca, Virgen Macarena University Hospital, Seville, Spain
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