Highlights
- •Depression and anxiety are common among Egyptian patients with type 1 diabetes.
- •Female sex is related to depression but not to anxiety.
- •HbA1c and HFS-II are independently correlated with both anxiety and depression.
- •Anxiety and depression are correlated with HFS-B, HFS-W and HFS-II total score.
Abstract
Background and aims
Emotional problems including anxiety, depression and fear of hypoglycemia (FOH) are
common in patients with type 1 diabetes mellitus (T1DM). The aim of this study was
to determine the prevalence of depressive and anxiety symptoms among patients with
T1DM and their relation to glycemic control, diabetes complications and to FOH.
Methods
This study included 325 patients with T1DM. Anxiety and depressive symptoms were assessed
by Hospital Anxiety and Depression Scale (HADS) and FOH was assessed by Hypoglycemia
Fear Survey II (HFS-II). Glycemic control was assessed by both fasting plasma glucose
and HbA1c. A subsample of 75 patients was screened for diabetes complications.
Results
The prevalence of anxiety symptoms, depressive symptoms and FOH was 76.3%, 61.8% and
20% respectively. Female sex was related to depressive symptoms but not to anxiety
symptoms. Logistic regression analysis showed that both HbA1c and HFS-II total score
were independently correlated with both anxiety symptoms and depressive symptoms.
Age showed independent correlation with both HFS-II (total score) and with Hypoglycemia
Fear Survey-worry (HFS-W) while HbA1c showed independent correlation with Hypoglycemia
Fear Survey-behavior (HFS-B). Both anxiety and depressive symptoms were positively correlated to HFS-B score,
HFS-W score and HFS-II total score.
Conclusions
FOH is not uncommon among Egyptian patients with T1DM and it seems to be one of the
factors contributing to the increased prevalence of anxiety and depressive symptoms
among those individuals. Addressing and managing the different psychological aspects
of diabetes should be integrated within the routine diabetes care services for people
with T1DM.
Abbreviations:
ABI (Ankle brachial index), FOH (fear of hypoglycemia), HADS (Hospital Anxiety and Depression Scale), HFS-II (Hypoglycemia Fear Survey II), T1DM (type 1 diabetes mellitus), UACR (urinary albumin to creatinine ratio), VPT (vibration perception threshold)Keywords
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References
- Prevention of type 1 diabetes.Br. Med Bull. 2011; 99: 73-88
American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes—2019. Diabetes care. 2019 Jan 1;42(Supplement_1):S13–28.
J.1 Aalders E.1 Hartman Nefs G1,2,3, Nieuwesteeg A1,4, Hendrieckx C5,6, Aanstoot HJ, et al. Mindfulness and fear of hypoglycaemia in parents of children with Type 1 diabetes: results from Diabetes MILES Youth - The Netherlands Diabet. Med 35 5 2018 May 650 657.
- Psychological conditions in adults with diabetes.Am. Psychol. 2016; 71: 552-562
- Hypoglycemia in type 1 diabetes: a still unresolved problem in the era of insulin analogs and pump therapy.Diabetes Care. 2008; 31: S121-S124
- The barrier of hypoglycemia in diabetes.Diabetes. 2008; 57: 3169-3176
- Hypoglycemia in type 1 diabetes mellitus.Endocrinol. Metab. Clin. North Am. 2010; 3: 641-654
- Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society.Diabetes Care. 2013; 36: 1384-1395
- Fear of hypoglycemia, anxiety, and subjective well-being in parents of children and adolescents with type 1 diabetes.J. Health Psychol. 2019; 24: 209-218
- Hypoglycaemia in type 1 diabetes: technological treatments, their limitations and the place of psychology.Diabetologia. 2018; 61: 761-769
- A critical review of the literature on fear of hypoglycemia in diabetes: Implications for diabetes management and patient education.Patient Educ. Couns. 2007; 68: 10-15
- Fear of hypoglycaemia—from normality to pathology. Diagnostic criteria and therapeutic directions.Clin. Diabetol. 2020; 9: 487-492
- Fear of hypoglycemia.J. Diabetes. 2017; 9: 108-110
- Predictive risk factors for fear of hypoglycemia and anxiety-related emotional disorders among adolescents with type 1 diabetes.Med. Princ. Pract. 2015; 24: 222-230
- Correlates of hypoglycemic fear in type I and type II diabetes mellitus.Health Psychol. 1992; 11: 199-202
- GEODE group. Fear of hypoglycaemia in patients with type 1 diabetes: do patients and diabetologists feel the same way?.Diabetes Metab. 2013; 39: 63-70
- 7th Edition of Idf Diabetes Atlas--Call for Immediate Action.Lijec. Vjesn. 2016; 138: 57-58
- The hospital anxiety and depression scale.Health Qual. Life Outcomes. 2003; 1: 29
- Retesting the validity of the Arabic version of the Hospital Anxiety and Depression (HAD) scale in primary health care.Soc. Psychiatry Psychiatr. Epidemiol. 1995; 30: 26-31
- Fear of hypoglycemia in type 1 diabetes managed by continuous subcutaneous insulin infusion: is it associated with poor glycemic control?.Diabetes Technol. Ther. 2011; 13: 93-98
- Health Measurement Scales: A Practical Guide to Their Development and Use.Oxford University Press, USA2014
- The prevalence of depression and anxiety in adults with type 1 diabetes.Diabet. Med. 2006; 23: 1381-1384
- Anxiety and depression symptoms in patients with diabetes.Diabet. Med. 2009; 26: 153-161
- Prevalence of symptoms of depression and anxiety in a diabetes clinic population.Diabet. Med. 2000; 17: 198-202
- Frequency and risk factors of depression in type 1 diabetes in a developing country.J. Pedia Endocrinol. Metab. 2017; 30: 917-922
- Prevalence of comorbid depression is high in out‐patients with Type 1 or Type 2 diabetes mellitus. Results from three out‐patient clinics in the Netherlands.Diabet. Med. 2010; 27: 217-224
- High prevalence of depression, anxiety and stress symptoms among diabetes mellitus patients.Open Psychiatry J. 2011; 5
- Depressed mood is a factor in glycemic control in type 1 diabetes.Psychosom. Med. 2001; 63: 551-555
- Depression is a risk factor for poor glycemic control and retinopathy in African-Americans with type 1 diabetes.Psychosom. Med. 2007; 69: 537-542
- Relationships of diabetes-specific emotional distress, depression, anxiety, and overall well-being with HbA 1c in adult persons with type 1 diabetes.J. Psychosom. Res. 2014; 77: 174-179
- Depression and diabetes.Diabetes Care. 2005; 28: 1904-1909
- Identification of risk factors for suffering fear of hypoglycemia in type 1 Diabetes Mellitus patients.Scand. J. Psychol. 2014; 55: 554-557
Mahabalshetti A.D., Ramdurg S.I., Dhananjaya M. Prevalence of Fear of Hypoglycemic Attack in Patients with Uncontrolled Diabetes Mellitus and Correlation Analysis in Diabetes.
- Psychometric properties of the hypoglycemia fear survey-ii for adults with type 1 diabetes.Diabetes Care. 2011; 34: 801-806
- Assessing fear of hypoglycemia among adults with type 1 diabetes–psychometric properties of the Norwegian version of the Hypoglycemia Fear Survey II questionnaire.Nor. Epidemiol. 2013; 23
- Fear of hypoglycaemia in adults with Type 1 diabetes: results from Diabetes MILES–The Netherlands.Diabet. Med. 2015; 32: 1289-1296
- Fear of hypoglycemia: relationship to hypoglycemic risk and psychological factors.Acta Diabetol. 2015; 52: 581-589
Article info
Publication history
Published online: March 14, 2023
Accepted:
March 5,
2023
Received in revised form:
February 22,
2023
Received:
November 16,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.
