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Fear of hypoglycemia (FoH) contributes to poor behavioral and glycemic outcomes. The ADA position statement on psychosocial care for people with diabetes recommends screening for FoH, with referral if positive. A clinically useful screener for FoH does not exist, hindering further actions by clinicians to address FoH in their patients. As part of a multi–phase study to develop a validated screener for FoH, we conducted semi–structured interviews with 10 healthcare providers (HCPs) (6 endocrinologists, 4 certified diabetes educators) who treat patients with T1D. The objective was to understand current clinical methods of identifying, diagnosing, and/or assessing FoH, HCP perceptions of T1D patients’ fear of, and experience with, hypoglycemia. Interviews were transcribed, de–identified, and thematically analyzed. Key themes were summarized for each interviewee and common themes across interviews were identified. All HCPs reported assessing patients for FoH through discussion. Most HCPs (7/10) did not use formal screeners for psychosocial issues. Instead, they evaluated patients with open ended questions about their feelings and experiences about low blood sugar. Some HCPs identified FoH behaviors based on CGM and insulin pump usage data; however, this method was not applicable for patients not using these technologies. Most HCPs (9/10) were not familiar with Blood Glucose Awareness Training as a formal program, which is recommended by the ADA to re–establish awareness of hypoglycemia and reduce FoH. Most HCPs made mental health referral decisions after observing anxiety, depression, or chronic poor management behaviors. Results suggest that although clinicians are aware of FoH, due to the lack of a formal screening tool, most HCPs rely on subjective judgment to determine the need for further psychosocial care referral. Creation of a screener will provide a standardized tool to better implement the ADA position statement of psychosocial care on the management of FoH.
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Development of a Fear of Hypoglycemia Screener: Type 1 Diabetes Health Care Provider Insight
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