Hypoglycemia is an almost unavoidable side effect of T1D treatment: adults with T1D experience 1 to 2 mild hypoglycemia episodes every week and 40% experience severe hypoglycemia (needing external assistance) annually. Since severe hypoglycemia can result in dangerous situations (e.g. in traffic), many people with T1D and their family members are afraid of hypoglycemia, including feelings of shame and embarrassment. Fear of hypoglycemia can interfere with diabetes (self) care, e.g. keeping blood glucose levels too high so as to prevent hypoglycemia, but increasing the risk of long-term complications. Fear of hypoglycemia also decreases quality of life (QoL). Thus, reducing fear of hypoglycemia can improve both clinical and quality of life outcomes. Educational/behavioural interventions aimed at reducing fear of hypoglycemia have been around for some time. However, existing reviews of the literature on these interventions have so far only been descriptive, not assessing their effectiveness. This systematic review and meta-analysis, co-authored by Diabeter psychologist Giesje Nefs, aimed to determine the effectiveness of interventions reducing fear of hypoglycemia.

The literature databases MEDLINE, EMBASE, CINAHL, and PsycINFO were searched from inception to 28 June 2021, using search terms relating to 1) adults with type T1D, 2) fear of hypoglycaemia and 3) behavioural and/or educational intervention, limiting the search to studies including participants 18+ years of age. Of 382 eligible studies, n=5 RCT studies and n=7 observational studies were included.

Key findings:

• Most included studies used the Hypoglycaemia Fear Survey Worry (HFS-W) and Behaviour (HFS-B) subscales
• On average, fear of hypoglycemia was relatively low at baseline
• Interventions showed a significant effect on HFS-W, but not on HFS-B
• Blood Glucose Awareness Training (BGAT) showed the largest effect on HFS-W and HFS-B scores
• One program based on Cognitive Behavioural Therapy (CBT) was as effective as BGAT in reducing HFS-B scores
• The program Dose Adjustment for Normal Eating (DAFNE) associated with significant reductions in fear of hypoglycemia

Concluding, the authors state

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