Research Article| Volume 17, ISSUE 3, P255-259, June 2023

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Relationship between depressive and anxiety symptoms and fear of hypoglycemia among adolescents and adults with type 1 diabetes mellitus

Published:March 14, 2023DOI:


      • 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.


      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.


      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.


      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.


      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.


      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)


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