Highlights
- •Motherhood, nocturnal hypoglycemia, and the number of blood glucose monitoring were correlated with parental FOH.
- •Psychological factors were conclusive and showed small-to-strong associations with parental fear of hypoglycemia.
- •Effective targeted interventions based on relevant factors can be developed to reduce the fear of hypoglycemia in parents.
Abstract
Problem
Fear of hypoglycemia is a significant concern for parents of children/ adolescents
with type 1 diabetes. Although some studies have explained the parental fear of hypoglycemia,
the related factors were yet to be determined. This systematic review aims to identify
the related factors of fear of hypoglycemia in the parents of children and adolescents
with type 1 diabetes and provide a theoretical basis for further intervention.
Eligibility criteria
PubMed, MEDLINE, EMBASE, Scopus, CINAHL, EBSCO, Web of Science, and Cochrane Library
were systematically searched from 2010 to 2021. Studies evaluating the fear of hypoglycemia
of parents and its associated factors were included.
Sample
Twenty-three observational articles met the criteria.
Results
Significant associations were found between fear of hypoglycemia and specific factors,
including motherhood, nocturnal hypoglycemia, and the number of blood glucose monitoring.
Psychological factors, including anxiety, depression, pediatric parenting stress,
mindfulness, self-efficacy, quality of life, and sleep disorders, were conclusive
and associations with parental fear of hypoglycemia.
Conclusions
Understanding parental fear of hypoglycemia can help parents prevent potential problems
in diabetes management, thus promoting children's growth. According to current evidence,
effective targeted interventions based on modifiable relevant factors can be developed
to reduce the fear of hypoglycemia in parents while maintaining optimal blood glucose
control in children/ adolescents.
Implications
Health professionals should pay more attention to the mental health of parents, and
parents should be involved in the care plan and have the opportunity to discuss their
fear of hypoglycemia in the most appropriate way to manage type 1 diabetes.
Keywords
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References
- Mindfulness and fear of hypoglycaemia in parents of children with Type 1 diabetes: Results from Diabetes MILES Youth—The Netherlands.Diabetic Medicine : A Journal of the British Diabetic Association. 2018; 35 (PubMed): 650-657
- When low blood sugars cause high anxiety: Fear of hypoglycemia among parents of youth with type 1 diabetes mellitus.Canadian Journal of Diabetes. 2021; 45 (Article 5. PubMed)
- Positioning time in range in diabetes management.Diabetologia. 2020; 63 (PubMed): 242-252
- Evaluating fear of hypoglycemia, pediatric parenting stress, and self-efficacy among parents of children with type 1 diabetes and their correlation with glycemic control.Medical Journal of the Islamic Republic of Iran. 2018; 32 (PubMed)119
- Nocturnal hypoglycemia and physical activity in children with diabetes: New insights by continuous glucose monitoring and accelerometry.Diabetes Care. 2016; 39 (PubMed): e95-e96
- Sex differences in anxiety and depression: Circuits and mechanisms.Nature Reviews. Neuroscience. 2021; 22 (PubMed): 674-684
- Fear of hypoglycaemia in parents of young children with type 1 diabetes: A systematic review.BMC Pediatrics. 2010; 10 (PubMed): 50
- Sleep and diabetes-specific psycho-behavioral outcomes of a new automated insulin delivery system in young children with type 1 diabetes and their parents.Pediatric Diabetes. 2021; 22 (PubMed): 495-502
- Multicenter trial of a tubeless, on-body automated insulin delivery system with customizable glycemic targets in pediatric and adult participants with type 1 diabetes.Diabetes Care. 2021; 44 (PubMed.): 1630-1640
- MYmind: Mindfulness training for youngsters with autism spectrum disorders and their parents.Autism : The International Journal of Research and Practice. 2015; 19 (PubMed): 906-914
- Predictive low-glucose insulin suspension reduces duration of nocturnal hypoglycemia in children without increasing ketosis.Diabetes Care. 2015; 38 (PubMed): 1197-1204
- Improvement in psychosocial outcomes in children with type 1 diabetes and their parents following subsidy for continuous glucose monitoring.Diabetes Technology & Therapeutics. 2019; 21 (PubMed): 575-580
- The use of continuous glucose monitoring with remote monitoring improves psychosocial measures in parents of children with type 1 diabetes: A randomized crossover trial.Diabetes Care. 2018; 41 (PubMed): 2641-2643
- Fear of hypoglycemia in Italian mothers of children with type 1 diabetes: The mediating role of resilience.Health Psychology Research. 2021; 9 (PubMed)27439
- Sustained impact of real-time continuous glucose monitoring in adults with type 1 diabetes on insulin pump therapy: Results after the 24-month RESCUE study.Diabetes Care. 2020; 43 (PubMed): 3016-3023
- Maternal fear of hypoglycemia in their children with insulin dependent diabetes mellitus.Journal of Pediatric Endocrinology & Metabolism : JPEM. 1998; 11 (PubMed): 189-194
- Improvements in parental sleep, fear of hypoglycemia, and diabetes distress with use of an advanced hybrid closed loop system.Diabetes Care. 2022; 45 (PubMed): 1292-1295
- A power primer.Psychological Bulletin. 1992; 112 (PubMed): 155-159
- The effect of peers support on fear of hypoglycemia in Iranian patients with type 1 diabetes: A clinical trial study.Iranian Journal of Nursing and Midwifery Research. 2021; 26 (PubMed): 162-167
- Mothers and fathers parenting stress and their perception of Children’s psychosocial functioning in Paediatric diabetes: A pilot study.International Journal of Environmental Research and Public Health. 2020; 17 (PubMed): Article 13
- Closed-loop insulin delivery systems in children and adolescents with type 1 diabetes.Expert Opinion on Drug Delivery. 2020; 17 (PubMed): 157-166
- Young children have higher variability of insulin requirements: Observations during hybrid closed-loop insulin delivery.Diabetes Care. 2019; 42 (PubMed): 1344-1347
- Fear of hypoglycemia in children and adolescents and their parents with type 1 diabetes.Current Diabetes Reports. 2016; 16 (PubMed): 77
- Weekend-based parent-group intervention to reduce stress in parents of children and adolescents with Type 1 diabetes: a pilot study.Journal of Diabetes Research. 2019; 2019 (PubMed): 7935945
- State of type 1 diabetes management and outcomes from the T1D exchange in 2016-2018.Diabetes Technology & Therapeutics. 2019; 21 (PubMed): 66-72
- The relationship between maternal fear of hypoglycaemia and adherence in children with type-1 diabetes.International Journal of Behavioral Medicine. 2014; 21 (PubMed): 804-810
- Benefits and challenges of current closed-loop technologies in children and young people with Type 1 diabetes.Frontiers in Pediatrics. 2021; 9 (PubMed)679484
- Assessing fear of hypoglycemia in children with type 1 diabetes and their parents.Diabetes Management (London, England). 2011; 1 (PubMed): 627-639
- Predictors of fear of hypoglycemia in adolescents with type 1 diabetes and their parents.Pediatric Diabetes. 2006; 7 (PubMed): 215-222
- Camp-based multi-component intervention for families of young children with type 1 diabetes: A pilot and feasibility study.Pediatric Diabetes. 2018; 19 (PubMed): 761-768
- Care of children with type 1 diabetes mellitus in school—An interventional study.Journal of Pediatric Endocrinology & Metabolism : JPEM. 2021; 34 (PubMed): 195-200
- Paternal involvement in pediatric type 1 diabetes: Fathers’ and mothers’ psychological functioning and disease management.Families, Systems & Health : The Journal of Collaborative Family Healthcare. 2012; 30 (PubMed): 47-59
- Management and family burdens endorsed by parents of Youth <7 years old with Type 1 diabetes.Journal of Diabetes Science and Technology. 2017; 11 (PubMed): 980-987
- Assessing fear of hypoglycemia in a population-based study among parents of children with type 1 diabetes—Psychometric properties of the hypoglycemia fear survey—Parent version.BMC Endocrine Disorders. 2015; 15 (PubMed): 2
- Fear of hypoglycaemia in mothers and fathers of children with Type 1 diabetes is associated with poor glycaemic control and parental emotional distress: A population-based study.Diabetic Medicine : A Journal of the British Diabetic Association. 2010; 27 (PubMed): 72-78
- Fear of hypoglycemia in parents of children with type 1 diabetes.Journal of Paediatrics and Child Health. 2014; 50 (PubMed): 639-642
- Decreasing trends in mean HbA are not associated with increasing rates of severe hypoglycemia in children: A longitudinal analysis of two contemporary population-based pediatric type 1 diabetes registries from Australia and Germany/Austria between 1995 and 2016.Diabetes Care. 2019; 42 (PubMed): 1630-1636
- The effect of 6-day subcutaneous glucose-dependent insulinotropic polypeptide infusion on time in glycaemic range in patients with type 1 diabetes: A randomised, double-blind, placebo-controlled crossover trial.Diabetologia. 2021; 64 (PubMed): 2425-2431
- Relations among school/daycare functioning, fear of hypoglycaemia and quality of life in parents of young children with type 1 diabetes.Journal of Clinical Nursing. 2015; 24 (PubMed): 1199-1209
- The impact of parents’ sleep quality and hypoglycemia worry on diabetes self-efficacy.Behavioral Sleep Medicine. 2015; 13 (PubMed): 308-323
- The Joanna Briggs Institute Critical Appraisal Tools.2017
- Sleep in children with type 1 diabetes and their parents in the T1D exchange.Sleep Medicine. 2017; 39 (PubMed): 108-115
- Hypoglycaemia, fear of hypoglycaemia and quality of life in children with Type 1 diabetes and their parents.Diabetic Medicine : A Journal of the British Diabetic Association. 2013; 30 (PubMed): 1126-1131
- Latent class analysis of lifestyle risk factors and association with overweight and/or obesity in children and adolescents: systematic review.Childhood Obesity (Print). 2021; 17 (Article 1. PubMed)
- Sleep and night-time caregiving in parents of children and adolescents with type 1 diabetes mellitus—A qualitative study.Behavioral Sleep Medicine. 2020; 18 (PubMed): 622-636
- A cognitive behavioral therapy intervention to reduce fear of hypoglycemia in young adults with type 1 diabetes (FREE): Study protocol for a randomized controlled trial.Trials. 2019; 20 (PubMed): 796
- A randomized clinical trial to assess the efficacy and safety of real-time continuous glucose monitoring in the management of type 1 diabetes in young children aged 4 to <10 years.Diabetes Care. 2012; 35 (PubMed): 204-210
- Depression as a predictor of hypoglycemia worry in parents of youth with recent-onset type 1 diabetes.Pediatric Diabetes. 2020; 21 (PubMed): 909-916
- An evaluation of glucagon injection anxiety and its association with the fear of hypoglycemia among the parents of children with type 1 diabetes.Journal of Clinical Research in Pediatric Endocrinology. 2021; 13 (PubMed): 285-292
- Continuous glucose monitoring in children with type 1 diabetes improves well-being, alleviates worry and fear of hypoglycemia.Diabetes Technology & Therapeutics. 2019; 21 (PubMed): 133-137
- Electroencephalogram spectral moments for the detection of nocturnal hypoglycemia.IEEE Journal of Biomedical and Health Informatics. 2020; 24 (PubMed): 1237-1245
- Graduated exposure to treat fear of hypoglycemia in a young adult with type 1 diabetes: A case study.Pediatric Diabetes. 2019; 20 (PubMed): 113-118
- The PRISMA 2020 statement: An updated guideline for reporting systematic reviews.BMJ (Clinical Research Ed.). 2021; 372 (PubMed): n71
- Fear of hypoglycemia, anxiety, and subjective well-being in parents of children and adolescents with type 1 diabetes.Journal of Health Psychology. 2019; 24 (PubMed): 209-218
- Worldwide estimates of incidence, prevalence and mortality of type 1 diabetes in children and adolescents: Results from the International Diabetes Federation Diabetes Atlas, 9th edition.Diabetes Research and Clinical Practice. 2019; 157 (PubMed): 107842
- Intervention to reduce hypoglycemia fear in parents of young kids using video-based telehealth (REDCHiP).Pediatric Diabetes. 2020; 21 (PubMed): 112-119
- Parental fear of hypoglycemia: Young children treated with continuous subcutaneous insulin infusion.Pediatric Diabetes. 2007; 8 (PubMed): 362-368
- Pediatric parenting stress and its relation to depressive symptoms and fear of hypoglycemia in parents of young children with type 1 diabetes mellitus.Journal of Clinical Psychology in Medical Settings. 2011; 18 (PubMed): 345-352
- Reexamining the hypoglycemia fear survey for parents of young children in a sample of children using insulin pumps.Diabetes Technology & Therapeutics. 2017; 19 (PubMed): 103-108
- Comorbidity of hypoglycaemia anxiety and panic disorder in a patient with type-1 diabetes—Combined treatment with cognitive-behavioral therapy and continuous glucose monitoring (CGM) in a psychosomatic day-treatment center.Deutsche Medizinische Wochenschrift (1946). 2020; 145 (PubMed): 314-317
- Sydney diabetes centre’s experience of the Australian Government’s roll out of subsidised continuous glucose monitoring for children with type 1 diabetes mellitus.Journal of Paediatrics and Child Health. 2019; 55 (PubMed): 1056-1062
- Randomized controlled clinical trial of blood glucose awareness training (BGAT III) in Switzerland and Germany.Journal of Behavioral Medicine. 2005; 28 (PubMed): 587-594
- Understanding the construct of fear of hypoglycemia in pediatric type 1 diabetes.Journal of Pediatric Psychology. 2014; 39 (PubMed): 1115-1125
- The role of a school nurse in the Care of a Child with diabetes mellitus type 1—The perspectives of patients and their parents.Literature Review. Zdravstveno Varstvo. 2018; 57 (PubMed): 166-174
- Detection and treatment efficacy of hypoglycemic events in the everyday life of children younger than 7 yr.Pediatric Diabetes. 2014; 15 (PubMed): 34-40
- Home use of day-and-night hybrid closed-loop insulin delivery in very young children: A multicenter, 3-week, randomized trial.Diabetes Care. 2019; 42 (PubMed): 594-600
- Severe hypoglycemia: Is it still a threat for children and adolescents with type 1 diabetes?.Frontiers in Endocrinology. 2020; 11 (PubMed): 609
- Mindfulness, worries, and parenting in parents of children with type 1 diabetes.Journal of Pediatric Psychology. 2019; 44 (PubMed): 499-508
- Nighttime is the worst time: Parental fear of hypoglycemia in young children with type 1 diabetes.Pediatric Diabetes. 2018; 19 (PubMed): 114-120
- Sex differences in fear extinction.Neuroscience and Biobehavioral Reviews. 2019; 103 (PubMed)
- Fear of hypoglycemia in children with type 1 diabetes and their parents: Effect of pump therapy and continuous glucose monitoring with option of low glucose suspend in the CGM TIME trial.Pediatric Diabetes. 2021; 22 (PubMed): 288-293
- Fear of hypoglycemia, parenting stress, and metabolic control for children with type 1 diabetes and their parents.Journal of Clinical Psychology in Medical Settings. 2017; 24 (PubMed): 74-81
- Language barriers restricting access to health care for indigenous populations.CMAJ : Canadian Medical Association Journal = Journal de L’Association Medicale Canadienne. 2018; 190 (PubMed): E754-E755
- ISPAD clinical practice consensus guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state.Pediatric Diabetes. 2018; 19 (PubMed): 155-177
- Continuous glucose monitoring decreases hypoglycemia avoidance behaviors, but not worry in parents of youth with new onset type 1 diabetes.Journal of Diabetes Science and Technology. 2021; 15 (PubMed): 1093-1097
- A psychoeducational program to restore hypoglycemia awareness: The DAFNE-HART pilot study.Diabetes Care. 2014; 37 (PubMed): 863-866
Article info
Publication history
Published online: June 16, 2022
Accepted:
May 27,
2022
Received in revised form:
May 9,
2022
Received:
January 21,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
