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The Relationship Between Child Nighttime Blood Glucose Values and Parent Fear of Nighttime Hypoglycemia in Families of Youth with Type 1 Diabetes
Monzon, Alexandra D
Monzon, Alexandra D
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Abstract
Objective: Youth with type 1 diabetes mellitus (T1D) are at risk for experiencing periods of nighttime hypoglycemia (i.e., nighttime low blood glucose levels). Due to this risk, many parents report significant nighttime fear and engage in maladaptive hypoglycemia avoidance behaviors at night (e.g., provide large snacks at bedtime, reduce insulin at night). To date, no study has used an objective measure of nighttime glucose to examine predictors of parent fear of nighttime hypoglycemia. Further, our current assessment tools to assess fear of hypoglycemia are lacking items that specifically assess fear of hypoglycemia specific to nighttime. The present study aimed to 1) add items to an existing measure to assess parent fear of nighttime hypoglycemia, 2) examine the psychometric properties of this modified measure, and 3) examine the relationship between parent fear of nighttime hypoglycemia and nighttime blood glucose levels as measured by continuous glucose monitors. Methods: In Phase I, the present study enrolled a sample of 10 pediatric diabetes healthcare providers (e.g., physicians, diabetes educators, pediatric psychologists) and 15 parents/caregivers of youth with T1D to generate items to add to an existing measure of fear of hypoglycemia. For Phase 2, the present study recruited an additional sample of 20 parents/caregivers of youth with T1D to pilot test the newly developed items. For Phase 3, the present study recruited a sample of 165 parents/caregivers of youth with T1D to examine the relationship between parents’ fear of nighttime hypoglycemia and child nighttime glucose values. The investigator evaluated structural validity via confirmatory factor analyses, reliability, and content validity of the modified measure to assess fear of nighttime hypoglycemia. Lastly, the investigator conducted a regression model with the child’s percent of nighttime glucose values in the hypoglycemic range as the independent variable and the parents’ modified fear of nighttime hypoglycemia total score as the dependent variable. Results: In Phase 1, The investigator generated 54 items from literature review and interviews. In Phase 2, seven items violated assumptions of distributional normality, 27 items demonstrated non-significant correlations, and two items were redundant. In Phase 3, the remaining 20 items demonstrated strong internal consistency (alpha=0.95). These items demonstrated strong to moderate relationships with criterion validity measures and strong to moderate relationships with content validity measures. Lastly, a four-factor model reflecting behaviors maintaining high glucose, helplessness, negative social consequences, and nighttime worries was the best fitting model χ2(519, n=136) = 815.33, p<0.001, RMSEA=0.065 90% CI [0.056-0.073], CFI=0.89, TLI=0.88. The results of the regression models revealed that youth’s percent of glucose values in the hypoglycemic range did not predict parents’ modified fear of nighttime hypoglycemia total score, however average youth nighttime glucose levels and nighttime glycemic variability were significant predictors of parents’ modified fear of nighttime hypoglycemia total score. Conclusions: The current study broadened the conceptualization of parent fear of hypoglycemia, and the results indicate that parents of youth with T1D may report higher fear of hypoglycemia if they observe increased fluctuations in their child’s nighttime glucose levels, regardless of how often their child’s glucose levels are in the hypoglycemic range. These findings are important to clinicians who may consider screening for parent fear of nighttime hypoglycemia and researchers interested in examining the relationship between parent fear of hypoglycemia and the use of T1D treatment devices.
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Date
2022-12-31
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University of Kansas
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Keywords
Clinical psychology, Blood glucose, Fear of hypoglycemia, Parent, Type 1 diabetes, Youth