Towards defining a cut-off score for elevated fear of hypoglycemia on the Hypoglycemia Fear Survey Worry subscale in patients with type 2 diabetes

T.R.S. Hajos, W.H. Polonsky, F. Pouwer, L. Gonder-Frederick, F.J. Snoek

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Objective
To determine a cutoff score for clinically meaningful fear of hypoglycemia (FoH) on the Hypoglycemia Fear Survey Worry subscale (HFS-W).
Research design and methods
Data on the HFS-W, history of hypoglycemia, emotional well-being (World Health Organization-5 well-being index), and distress about diabetes symptoms (Diabetes Symptom Checklist–Revised) were available from Dutch patients with type 2 diabetes who were treated with oral medication or insulin (n = 1,530). Four criteria were applied to define a threshold for clinically meaningful FoH: 1) modal score distribution (MD criterion), 2) scores 2 SDs above the mean (SD criterion), 3) concurrent validity with severe hypoglycemia and suboptimal well-being (CV criterion), and 4) an elevated score (≥3) on more than one HFS-W item (elevated item endorsement [EI criterion]). Associations between the outcomes of these approaches and a history of severe hypoglycemia and suboptimal well-being were studied.
Results
Of the 1,530 patients, 19% had a HFS-W score of 0 (MD criterion), and 5% reported elevated FoH (HFS-W ≥ mean + 2 SD; SD criterion). Patients with severe hypoglycemia reported higher HFS-W scores than those without (25 ± 20 vs. 15 ± 17; P < 0.001). Patients with suboptimal well-being reported higher HFS-W scores than those with satisfactory well-being (20 ± 18 vs. 13 ± 15; P < 0.001, CV criterion). Elevated FoH (defined by the EI criterion) was seen in 26% of patients. The SD and EI criteria were the strongest associated with history of severe hypoglycemia. The EI criterion was the strongest associated with suboptimal well-being.
Conclusions
Although no definite cutoff score has been determined, the EI criterion may be most indicative of clinically relevant FoH in this exploratory study. Further testing of the clinical relevance of this criterion is needed.
Original languageEnglish
Pages (from-to)102-108
JournalDiabetes Care: The Journal of Clinical and Applied Research and Education
Volume37
DOIs
Publication statusPublished - 2014

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Hypoglycemia
Type 2 Diabetes Mellitus
Surveys and Questionnaires

Cite this

@article{318b6c8d49ac438299ea910eefea55b6,
title = "Towards defining a cut-off score for elevated fear of hypoglycemia on the Hypoglycemia Fear Survey Worry subscale in patients with type 2 diabetes",
abstract = "ObjectiveTo determine a cutoff score for clinically meaningful fear of hypoglycemia (FoH) on the Hypoglycemia Fear Survey Worry subscale (HFS-W).Research design and methodsData on the HFS-W, history of hypoglycemia, emotional well-being (World Health Organization-5 well-being index), and distress about diabetes symptoms (Diabetes Symptom Checklist–Revised) were available from Dutch patients with type 2 diabetes who were treated with oral medication or insulin (n = 1,530). Four criteria were applied to define a threshold for clinically meaningful FoH: 1) modal score distribution (MD criterion), 2) scores 2 SDs above the mean (SD criterion), 3) concurrent validity with severe hypoglycemia and suboptimal well-being (CV criterion), and 4) an elevated score (≥3) on more than one HFS-W item (elevated item endorsement [EI criterion]). Associations between the outcomes of these approaches and a history of severe hypoglycemia and suboptimal well-being were studied.ResultsOf the 1,530 patients, 19{\%} had a HFS-W score of 0 (MD criterion), and 5{\%} reported elevated FoH (HFS-W ≥ mean + 2 SD; SD criterion). Patients with severe hypoglycemia reported higher HFS-W scores than those without (25 ± 20 vs. 15 ± 17; P < 0.001). Patients with suboptimal well-being reported higher HFS-W scores than those with satisfactory well-being (20 ± 18 vs. 13 ± 15; P < 0.001, CV criterion). Elevated FoH (defined by the EI criterion) was seen in 26{\%} of patients. The SD and EI criteria were the strongest associated with history of severe hypoglycemia. The EI criterion was the strongest associated with suboptimal well-being.ConclusionsAlthough no definite cutoff score has been determined, the EI criterion may be most indicative of clinically relevant FoH in this exploratory study. Further testing of the clinical relevance of this criterion is needed.",
author = "T.R.S. Hajos and W.H. Polonsky and F. Pouwer and L. Gonder-Frederick and F.J. Snoek",
year = "2014",
doi = "10.2337/dc13-0971",
language = "English",
volume = "37",
pages = "102--108",
journal = "Diabetes Care: The Journal of Clinical and Applied Research and Education",
issn = "0149-5992",
publisher = "AMER DIABETES ASSOC",

}

Towards defining a cut-off score for elevated fear of hypoglycemia on the Hypoglycemia Fear Survey Worry subscale in patients with type 2 diabetes. / Hajos, T.R.S.; Polonsky, W.H.; Pouwer, F.; Gonder-Frederick, L.; Snoek, F.J.

In: Diabetes Care: The Journal of Clinical and Applied Research and Education, Vol. 37, 2014, p. 102-108.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Towards defining a cut-off score for elevated fear of hypoglycemia on the Hypoglycemia Fear Survey Worry subscale in patients with type 2 diabetes

AU - Hajos, T.R.S.

AU - Polonsky, W.H.

AU - Pouwer, F.

AU - Gonder-Frederick, L.

AU - Snoek, F.J.

PY - 2014

Y1 - 2014

N2 - ObjectiveTo determine a cutoff score for clinically meaningful fear of hypoglycemia (FoH) on the Hypoglycemia Fear Survey Worry subscale (HFS-W).Research design and methodsData on the HFS-W, history of hypoglycemia, emotional well-being (World Health Organization-5 well-being index), and distress about diabetes symptoms (Diabetes Symptom Checklist–Revised) were available from Dutch patients with type 2 diabetes who were treated with oral medication or insulin (n = 1,530). Four criteria were applied to define a threshold for clinically meaningful FoH: 1) modal score distribution (MD criterion), 2) scores 2 SDs above the mean (SD criterion), 3) concurrent validity with severe hypoglycemia and suboptimal well-being (CV criterion), and 4) an elevated score (≥3) on more than one HFS-W item (elevated item endorsement [EI criterion]). Associations between the outcomes of these approaches and a history of severe hypoglycemia and suboptimal well-being were studied.ResultsOf the 1,530 patients, 19% had a HFS-W score of 0 (MD criterion), and 5% reported elevated FoH (HFS-W ≥ mean + 2 SD; SD criterion). Patients with severe hypoglycemia reported higher HFS-W scores than those without (25 ± 20 vs. 15 ± 17; P < 0.001). Patients with suboptimal well-being reported higher HFS-W scores than those with satisfactory well-being (20 ± 18 vs. 13 ± 15; P < 0.001, CV criterion). Elevated FoH (defined by the EI criterion) was seen in 26% of patients. The SD and EI criteria were the strongest associated with history of severe hypoglycemia. The EI criterion was the strongest associated with suboptimal well-being.ConclusionsAlthough no definite cutoff score has been determined, the EI criterion may be most indicative of clinically relevant FoH in this exploratory study. Further testing of the clinical relevance of this criterion is needed.

AB - ObjectiveTo determine a cutoff score for clinically meaningful fear of hypoglycemia (FoH) on the Hypoglycemia Fear Survey Worry subscale (HFS-W).Research design and methodsData on the HFS-W, history of hypoglycemia, emotional well-being (World Health Organization-5 well-being index), and distress about diabetes symptoms (Diabetes Symptom Checklist–Revised) were available from Dutch patients with type 2 diabetes who were treated with oral medication or insulin (n = 1,530). Four criteria were applied to define a threshold for clinically meaningful FoH: 1) modal score distribution (MD criterion), 2) scores 2 SDs above the mean (SD criterion), 3) concurrent validity with severe hypoglycemia and suboptimal well-being (CV criterion), and 4) an elevated score (≥3) on more than one HFS-W item (elevated item endorsement [EI criterion]). Associations between the outcomes of these approaches and a history of severe hypoglycemia and suboptimal well-being were studied.ResultsOf the 1,530 patients, 19% had a HFS-W score of 0 (MD criterion), and 5% reported elevated FoH (HFS-W ≥ mean + 2 SD; SD criterion). Patients with severe hypoglycemia reported higher HFS-W scores than those without (25 ± 20 vs. 15 ± 17; P < 0.001). Patients with suboptimal well-being reported higher HFS-W scores than those with satisfactory well-being (20 ± 18 vs. 13 ± 15; P < 0.001, CV criterion). Elevated FoH (defined by the EI criterion) was seen in 26% of patients. The SD and EI criteria were the strongest associated with history of severe hypoglycemia. The EI criterion was the strongest associated with suboptimal well-being.ConclusionsAlthough no definite cutoff score has been determined, the EI criterion may be most indicative of clinically relevant FoH in this exploratory study. Further testing of the clinical relevance of this criterion is needed.

U2 - 10.2337/dc13-0971

DO - 10.2337/dc13-0971

M3 - Article

VL - 37

SP - 102

EP - 108

JO - Diabetes Care: The Journal of Clinical and Applied Research and Education

JF - Diabetes Care: The Journal of Clinical and Applied Research and Education

SN - 0149-5992

ER -