Intervention to Reduce Fear of Hypoglycemia and Optimize Type 1 Diabetes Outcomes

项目摘要/摘要 NIDDK将低血糖描述为“预防糖尿病并发症的治疗的致命弱点”。 低血糖导致“难以达到血糖目标，因为[患者和父母的] 眼下对低血糖的恐惧盖过了他们对长期并发症的恐惧。 常见的急性副作用(如出汗和心悸等身体不适症状) 强化胰岛素治疗严重干扰了糖尿病患者血糖的最佳控制 1型糖尿病(T1D)。严重低血糖危及生命，当体内葡萄糖不足时会发生。 大脑会导致认知障碍、意识丧失或癫痫发作。 作为患者或患有T1D儿童的父母，低血糖发作的经历可能是 心理创伤。许多研究证明，对低血糖的恐惧会增加焦虑 关于T1D治疗方案导致的“低血糖避免行为”，包括 过度警惕的血糖监测，治疗低血糖水平与过量 碳水化合物，以及通过故意抑制胰岛素来维持高血糖。最终， 不适当的行为来抵消低血糖会导致血糖控制不佳和长期 并发症。因此，帮助T1D患者和他们的父母采用适应性是至关重要的 对抗低血糖和高血糖的行为。 该项目的总体目标和主要目标是解决确定和 提供担心低血糖的干预措施，这将通过随机进行试点来实现 用于评估血糖意识训练效果的临床试验，该训练已被适应，但 从未在使用胰岛素泵的患有T1D的青少年和他们的父母中进行评估。此外，我们还将建立 可能增加儿童版和父母版低血糖恐惧的临床实用性的临界值 调查，这是目前唯一一份评估低血糖恐惧的问卷。如果这个项目的目标能够实现 通过以下措施：1)建立儿童T1D患者及其父母的临床护理体系 循证干预以治疗对低血糖的恐惧；以及2)提高 低血糖恐惧症调查。这个项目具有创新性和重要意义，因为它将测试一种干预 专为那些高度害怕低血糖的人开发的，低血糖是胰岛素泵的潜在原因 不粘连，是充分利用胰岛素泵提供的技术进步的重大障碍。 这种干预有可能变得更广泛地传播到一种机械化的治疗和 培训材料，以便各种糖尿病护理提供者能够实施干预 T1D患者及其父母的技术。

Project Summary/Abstract NIDDK describes hypoglycemia as “an Achilles heel in therapy to prevent diabetes complications.” Hypoglycemia causes “difficulties with meeting blood glucose targets because [patients' and parents'] immediate fear of hypoglycemia overshadows their fear of long-term complications.” Hypoglycemia is the most common acute side effect (e.g., unpleasant physical symptoms such as sweating and heart palpitations) of intensive insulin therapy and it significantly interferes with achieving optimal glycemic control in patients with type 1 diabetes (T1D). Severe hypoglycemia is life-threatening and occurs when a shortage of glucose in the brain results in cognitive impairment, unconsciousness, or seizure. The experience of hypoglycemic episodes as a patient or a parent of a child with T1D can be psychologically traumatizing. Many studies have documented that fear of hypoglycemia increases anxiety about the T1D treatment regimen leading to engagement in “hypoglycemia avoidance behaviors,” including over-vigilant blood glucose monitoring, treating low blood glucose levels with excessive amounts of carbohydrates, and maintaining high blood glucose by intentionally withholding insulin. Ultimately, inappropriate behaviors to counteract hypoglycemia can lead to poor glycemic control and long-term complications. Thus, it is critically important to assist patients with T1D and their parents to adopt adaptive behaviors to counteract hypo- and hyperglycemia. The overall objective and Primary Aim of this project is to address the critical need of identifying and providing intervention for fear of hypoglycemia, which will be accomplished by conducting a pilot, randomized clinical trial to evaluate the efficacy of Blood Glucose Awareness Training, which has been adapted for, but never evaluated in adolescents with T1D who use insulin pumps and their parents. In addition, we will establish cutoff scores that may increase the clinical utility of the Child and Parent Versions of the Hypoglycemia Fear Survey, the only existing questionnaires to assess fear of hypoglycemia. If the aims of this project are achieved clinical care of pediatric patients with T1D and their parents will be substantially improved by 1) establishing an evidence-based intervention to treat fear of hypoglycemia; and 2) improving the clinical utility of the Hypoglycemia Fear Survey. This project is innovative and significant because it will test an intervention specifically developed for those with high fear of hypoglycemia, a potential cause of insulin pump nonadherence and a significant impediment to full utilization of the technological advances insulin pumps offer. This intervention has the potential to become more widely disseminated into a manualized treatment and training materials so that a variety of diabetes care providers will be able to implement the intervention techniques with patients with T1D and their parents.