Impact of fear of hypoglycemia in adolescents with T1D varies by potential associations


Fear of hypoglycemia (FOH) among youth and adolescents with type 1 diabetes (T1D) can lead to impaired sleep but may not negatively affect physical activity.

CGM system on child's arm. | Image Credit: © habrovich - © habrovich -

CGM system on child's arm. | Image Credit: © habrovich - © habrovich -

Fear of hypoglycemia (FOH) can contribute to impaired sleep for adults with type 1 diabetes (T1D) and parents of children with T1D. According to a study published in Diabetic Medicine, FOH was associated with impaired sleep among adolescents with T1D as well.1

The relationship of adolescent FOH and sleep were examined in the study, which also assessed the influences of continuous glucose monitoring (CGM) and insulin pump use. Adolescents with T1D aged 14 to 18 years completed questionnaires to evaluate FOH.1 The Child Hypoglycemia Fear Survey and Pittsburgh Sleep Quality Index (PSQI) were used for evaluations.

In total, 95 adolescents (52 female) participated in the study and the interquartile (IQR) age of participants was 16.5 (15.3-17.7) years with an IQR T1D duration of 5.7 (2.5-9.6) years.1 Results demonstrated that increased FOH-Worry subscale scores were linked to reduced sleep duration among participants (β = -0.03, P = 0.042 [adjusting for BMI z-score and race and ethnicity]). Increased FOH-Worry subscale scores were also associated with increased sleep disturbances (OR = 1.1, P = 0.038 [adjusting for race and ethnicity]).

Longer sleep duration (average 7.5 hours) was observed in frequent CGM users compared to infrequent or non-CGM users (average = 6.8 hours [P = 0.029]).1 Investigators determined use of technology did not have significant interactions in the relationships between FOH and sleep disturbances or duration.The study authors concluded, “worrying about hypoglycemia was associated with impaired sleep for adolescents with T1D.”

Other studies aimed to determine how FOH impacts youth and adolescents with T1D in other aspects of life, such as physical activity (PA), have demonstrated differing results. PA-related studies have indicated FOH among youth and adolescents as a potential barrier to participating in PA.2 According to a study published in Pediatric Diabetes that examined PA patterns among youth with T1D, FOH could be less of a PA barrier than previously thought. 

The SEARCH for Diabetes in Youth (SEARCH) is a national, multi-center study aimed at understanding diabetes among children and young adults in the United States, with study centers in South Carolina, Ohio, Colorado, California, and Washington.3

A cross-sectional analysis of the SEARCH cohort study of youth and adolescents aged 10 to 17 years with T1D (n = 1129) was conducted, according to study authors.2 Associations between the self-reported number of vigorous PA (VPA) days and moderate PA (MPA) days, and both youth- and parent-reported FOH were estimated by linear regression models.2 Multivariable models were adjusted for sex, race, age, duration of T1D, HbA1c, use of CGM, recent severe hypoglycemia, primary insulin regimen, and BMI.2

Of those participating, 52% were female, had a mean (SD) age of 14.4 (4.2) years, diabetes duration of 7.5 years, and HbA1c 9.2% (1.7).2 Older youth were less likely to participate in team sports or VPA (P < .01), but were more likely to participate in MPA (P < .01). Increased youth FOH (behavior subscale) was associated with increased levels of VPA (β [se] 0.30 [0.11], P = .0), but was not significantly associated with MPA (P = .06) and no significant associations between parental FOH and youth PA.

VPA and team sports participation declined with age while MPA increased among SEARCH participants with T1D. According to results, authors observed, “that higher scores on the youth FOH behavioral subscale were associated with increased VPA levels, suggesting that FOH may be less of a barrier to PA than previously thought.”2 


1. Hitt TA, Hershey JA, Olivos-Stewart D, et al. The impact of fear of hypoglycaemia on sleep in adolescents with type 1 diabetes. Diabet Med. 2023;40(5):e15066. doi:10.1111/dme.15066

2. Roberts AJ, Taplin CE, Isom S, et al. Association between fear of hypoglycemia and physical activity in youth with type 1 diabetes: The SEARCH for diabetes in youth study. Pediatr Diabetes. 2020;21(7):1277-1284. doi:10.1111/pedi.13092

3. Search for diabetes in youth. Accessed April 20, 2023.

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