Fear of hypoglycemia is reduced in Type 1 diabetes patients who receive therapy, study finds

For some individuals with Type 1 diabetes, fear of hypoglycemia - or low blood sugar - can lead to sleeplessness, anxiety, increased glucose variability and difficulty managing their disease.

"It's appropriate to feel some worry, but [in focus groups we heard from] people living with Type 1 diabetes who had consistently and repeatedly identified how fear of hypoglycemia was a barrier and a stressor in their ability to care for their diabetes - an ever-present anxiety," said Pamela Martyn-Nemeth, professor of biobehavioral nursing science in the College of Nursing.

To address this, Martyn-Nemeth and her team undertook a pilot study of 50 young adults ages 18 to 35 with fear of hypoglycemia to test an eight-week cognitive behavioral therapy intervention called Fear Reduction Efficacy Evaluation, or FREE.

What they found is that study participants who received the intervention had a significant reduction in fear of hypoglycemia compared with a control group, according to a paper published in the Journal of Psychosomatic Research in June. They also had a significant improvement in self-management behavior and glucose control, based on time-in-range standards. Martyn-Nemeth was the lead author on the paper, which received the journal's Editor's Choice Award in October.

Individuals in the FREE group received eight weekly one-hour individual sessions using cognitive behavior therapy, a type of counseling aimed to modify maladaptive thoughts and behaviors through cognitive restructuring, relaxation training and exposure therapy. Those individuals in the control group received eight weekly one-hour individual diabetes sessions.

Both groups received continuous glucose monitoring technology, but only those in the FREE group were taught to use the information as a "biofeedback cue," a check on their decision-making.

Sessions were conducted in-person initially but shifted to videoconferencing during the COVID-19 pandemic. There was no difference in results based on whether the counseling was in-person counseling or remote, according to the paper.

Martyn-Nemeth says she hopes to expand the study - this time conducting it entirely remotely - to see whether it could be scaled or even integrated into general diabetes care.

"We did focus groups with participants after the study," Martyn-Nemeth said. "That was very eye-opening because whether they received [the intervention] in-person or remotely, they indicated how essential and important this was for them. [They shared] how they began to think about diabetes in a different way and that they never considered how their emotions could play into it. Many thought eight weeks wasn't enough; this was just the tip of the iceberg. They wanted more."

Co-authors from UIC Nursing included Katherine M. Minnich Endowed Professor Laurie Quinn, PhD '96, research assistant professor Chang Park, and research specialist Minsun Park, PhD '16. Three-time alum Sue Penckofer, PhD '93, MS '82, BSN '79, emeritus professor Marcella Niehoff School of Nursing at Loyola University Chicago, was also a co-author.

- Written by Deborah Ziff Soriano