Traducción al español, adaptación y validación de un cuestionario sobre el miedo a la hipoglucemia y su relación con distintas variables clínicas en una población con diabetes mellitus tipo1 de la Comunidad de Madrid

Abstract

Hypoglycemia remains the mayor limiting factor in achieving optimal blood glucose control in persons with type 1 diabetes (T1D). In many individuals with diabetes, the unpleasant symptoms and negative consequences associated with hypoglycemia may result in fear of hypoglycemia (FOH). This fear may have significant clinical implications for diabetes self-management, psychological well-being and quality of life. In this context is crucial to diagnose individuals at risk of fear of hypoglycemia. Fear of hypoglycemia can be assessed with the Hypoglycemia Fear Survey (HFS) published by Cox et colleague in 1987 which had been adapted to many countries, not in Spain and it is still the gold standard in this field. Objectives. 1)To translate, adapt and validate de original HFS into a Spanish version of the Fear of Hypoglycemia survey (EsHFS). 2)To examine sociodemographic and clinical factors associated with fear of hypoglycemia in adults with T1D. Results. The HFS was translated using the forward-backward translation method and was thereafter answered by 163 T1D. One-hundred and sixty-three subjects with T1D answered the Spanish version of HFS, EsHFS. Mean age (SD) 36 (10) years, mean diabetes duration 18 years, 55% women, 60% married/having a partner, 32% with university studies, 24% using insulin pumps, mean HbA1c 7.7%, 54% had severe hypoglycemia events reported and 35% had impaired awareness of hypoglycemia. A three-factor solution showed the best fit for EsHFS, HFS-Worry subscale and with two subscales emerging from the HFS-Behaviour subescale, one representing tendencies towards maintenance of high blood glucose and the other behavior to avoid hypoglycemia. Subscale item analysis showed excellent fit, with a Cronbach α coefficient for internal validity of 0.92, a correlation coefficient for test-retest reliability of r=0.92 and a good point measure correlation. Several clinical factors: gender (female), age, level of studies, having a partner, self-monitoring, pump therapy and HbA1c>8.4% were significantly associated with the EsHFS scores. The EsHFS was significantly associated with: frequency of non-severe hypoglycemia, subjects who had experienced history of severe hypoglycemia and hypoglycemia unawareness, on which the scores were higher. Conclusions. The Spanish version of the HFS, EsHFS, displayed good psychometric properties. It is known that fear of hypoglycemia is related to some social and clinical variables. Knowledge of these variables as well as the use of EsHFS could be helpful to identify patients with higher fear to suffer hypoglycemia who may benefit from interventions to reduce it. The EsHFS could be considered a useful tool for evaluating fear of hypoglycemia in patients with T1D Spanish-speakers from our country.