The Relationship Between Fear Of Hypoglycemia And Psychological Insulin Resistance In Individuals with Type 2 Diabetes

Yıl 2026, Cilt: 7 Sayı: 1 , 1 - 12 , 01.04.2026

Sena İnce , Tülay Kars Fertelli

https://izlik.org/JA39AX53DP

Öz

Giriş: Tip 2 diyabetli bireylerde hipoglisemi korkusu ile psikolojik insülin direnci arasındaki ilişki daha önce incelenmemiştir. Bu ilişkinin anlaşılması, diyabetli bireylerde başarılı hastalık yönetiminin sağlanması açısından önemlidir.
Amaç: Bu çalışma, tip 2 diyabetli bireylerde hipoglisemi korkusu ve psikolojik insülin direnci arasındaki ilişkiyi incelemek amacıyla yapılmıştır.
Yöntem: Çalışma, Mart-Haziran 2024 tarihleri arasında bir üniversite hastanesinin endokrinoloji ve dahiliye kliniğinde yatan ve dahil edilme kriterlerini karşılayan 246 tip 2 diyabetli bireyle ile yapıldı. Veriler, hasta tanıtım formu, Hipoglisemi Korku Ölçeği (HKÖ) ve Psikolojik İnsülin Direnci Ölçeği (PİDÖ) kullanılarak toplandı. Veriler, tanımlayıcı ve analitik istatistikleri birleştiren SPSS İstatistiksel yazılımı (Sürüm 22) kullanılarak analiz edildi.
Bulgular: Katılımcıların HKÖ ve PİDÖ toplam puan ortalamaları sırasıyla 18,08±20,95 ve 42,03±9,14 olarak bulundu. Katılımcıların HKÖ ve PİDÖ toplam puan ortalamaları arasında düşük düzeyde, negatif yönde (r:-0,159; p: 0.013) anlamlı bir ilişki bulundu (r: 0,467, p:0,000). Ayrıca, hipoglisemi korkusunun psikolojik insülin direncinin bir yordayıcısı olduğu belirlendi.
Sonuç: Diyabetli bireylerde hipoglisemi korkusu arttıkça psikolojik insülin direncinin azaldığı tespit edilmiştir. Bu nedenle, sağlık profesyonellerinin diyabetli bireylerde hastalığın başarılı bir şekilde yönetilmesini sağlamak için hipoglisemi korkusunu ve psikolojik insülin direncini değerlendirmeleri önerilmektedir.

Anahtar Kelimeler

Tip 2 diyabet , hipoglisemi korkusu , psikolojik insülin direnci

Etik Beyan

Etik onay: Bu çalışma Helsinki Bildirgesi ilkelerine uygun olarak yürütüldü ve araştırma protokolü Üniversite Klinik Araştırmalar Etik Kurulu tarafından onaylandı (Etik onay numarası: 2023-06/55).

Destekleyen Kurum

Yazarlar bu yazının hazırlanması sırasında herhangi bir fon, hibe veya başka bir destek almadıklarını beyan ederler.

Proje Numarası

-

Teşekkür

Çalışmaya katılan tüm katılımcılara teşekkür ederiz.

The Relationship Between Fear Of Hypoglycemia And Psychological Insulin Resistance In Individuals with Type 2 Diabetes

https://izlik.org/JA39AX53DP

Öz

Abstract
Introduction: The relationship between fear of hypoglycemia and psychological insulin resistance in individuals with type 2 diabetes has not been previously investigated. Understanding this relationship is crucial for successful disease management in individuals with diabetes.
Objectives: The relationship between fear of hypoglycemia and psychological insulin resistance in individuals with type 2 diabetes has not been previously examined. This study was conducted to examine the relationship between fear of hypoglycemia and psychological insulin resistance in individuals with type 2 diabetes. Understanding this relationship is important for ensuring successful disease management in individuals with diabetes.
Methods: The study was conducted with 246 individuals with type 2 diabetes who met the inclusion criteria and were hospitalized in the endocrinology and internal medicine clinic of a university hospital between March and June 2024. Data were collected using a patient identification form, the Hypoglycemia Fear Scale, and the Psychological Insulin Resistance Scale. Data were analyzed using SPSS Statistical Software (Version 22), which combines descriptive and analytical statistics.
Results: The participants' total mean scores on the hypoglycemia fear scale and psychological insulin resistance scale were 18.08±20.95 and 42.03±9.14, respectively. A low-level, negative correlation (r: -0.159; p: 0.013) was found between participants' total hypoglycemia fear scale and psychological insulin resistance scale scores (r: 0.467, p: 0.000). Furthermore, fear of hypoglycemia was found to predict psychological insulin resistance.
Conclusion: It has been found that as fear of hypoglycemia increases in individuals with diabetes, psychological insulin resistance decreases. Therefore, healthcare professionals are advised to assess hypoglycemia fear and psychological insulin resistance to ensure successful disease management in individuals with diabetes.

Anahtar Kelimeler

Type 2 diabetes , fear of hypoglycemia , psychological insulin resistance

Etik Beyan

Ethical approval: This study was performed in compliance with the principles of the Declaration of Helsinki, and the research protocol was approved by the University’s Clinical Research Ethics Board (Ethical approval number: 2023-06/55).

Destekleyen Kurum

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Proje Numarası

-

Teşekkür

We would like to thank all the study participants.

Kaynakça

• 1. Fariba A, Amerzadeh M, Banazadeh M, Rashidi S, Myaneh ZT. Fear of hypoglycemia and illness perception in type II diabetes patients. BMC Endocr Disord. 2024;24(1):24. https://doi.org/10.1186/s12902-024-01548-x
• 2. Büyükkaya Besen D, Dervişoğlu M. Validity and reliability of the Hypoglycemic Confidence Scale. Turkiye Klinikleri J Nurs Sci. 2021;13(1):120-129. https://doi.org/10.5336/nurses.2020-77284
• 3. Özkaptan BB, Demirci İ. Determination of factors associated with fear of hypoglycemia and self-efficacy perception in diabetic patients using insulin. Süleyman Demirel Üniversitesi Tıp Fak Derg. 2023;30(1):25-36. https://doi.org/10.17343/sdutfd.1181696
• 4. Przezak A, Bielka W, Molęda P. Fear of hypoglycemia—An underestimated problem. Brain Behav. 2022;12(7):e2633. https://doi.org/10.1002/brb3.2633
• 5. Wang Y, Zeng Z, Ding J, et al. Fear of hypoglycaemia among patients with type 2 diabetes mellitus: a cross-sectional study. Sci Rep. 2021;11(1):7971. https://doi.org/10.1038/s41598-021-87039-y
• 6. Erol O, Enc N. Hypoglycemia fear and self-efficacy of Turkish patients receiving insulin therapy. Asian Nurs Res (Korean Soc Nurs Sci). 2011;5(4):222-228. https://doi.org/10.1016/j.anr.2011.12.001
• 7. Khunti K, Alsifri S, Aronson R, et al; HAT Investigator Group. Impact of hypoglycaemia on patient-reported outcomes from a global, 24-country study of 27,585 people with type 1 and insulin-treated type 2 diabetes. Diabetes Res Clin Pract. 2017; 130:121-129. https://doi.org/10.1016/j.diabres.2017.05.018
• 8. Anderbro T, Gonder-Frederick L, Bolinder J, et al. Fear of hypoglycemia: relationship to hypoglycemic risk and psychological factors. Acta Diabetol. 2015;52(3):581-589. https://doi.org/10.1007/s00592-014-0694-8
• 9. Huang J, Peng W, Ding S, Xiong S, Liu Z. Fear of hypoglycemia and associated factors in hospitalized patients with type 2 diabetes: a cross-sectional study. Sci Rep. 2022;12(1):20338. https://doi.org/10.1038/s41598-022-24756-y
• 10. Can S, Çiçek SC. Fear of hypoglycemia and evaluation of hypoglycemia management in individuals with type 2 diabetes. Turk J Diabetes Nurs. 2024;4(1):14-20. https://doi.org/10.29228/tjdn.78904
• 11. Krawczyk J, Duda-Sobczak A, Zozulińska-Ziółkiewicz D. Fear of hypoglycaemia—from normality to pathology. Clin Diabetol. 2020;9(6):487-492. https://doi.org/10.5603/DK.2020.0078
• 12. Pang J, Zhang L, Li X, et al. Identification of factors associated with fear of hypoglycemia using the COM-B model in people with type 2 diabetes mellitus: a cross-sectional study. Acta Diabetol. 2023;60(10):1405-1415. https://doi.org/10.1007/s00592-023-02080-6
• 13. Işık K, Yıldırım H, Cengiz Z. Adaptation of the Psychological Insulin Resistance Scale into Turkish for diabetic patients. Turk J Fam Med Prim Care. 2021;15(4):726-733. https://doi.org/10.21763/tjfmpc.840514
• 14. Zhang S, Zhang X, Wang H, et al. Factors associated with psychological insulin resistance among patients with type 2 diabetes in China. Front Endocrinol (Lausanne). 2024; 15:1368132. https://doi.org/10.3389/fendo.2024.1368132
• 15. Patnaik S, Mohanty P, Bhuyan SK, Das J, Mohapatra N. Psychological insulin resistance and its association with glycemic control among patients with diabetes mellitus: a cross-sectional study. SSR Inst Int J Life Sci. 2025;11(3):7580-7587. https://doi.org/10.5281/zenodo.13326713
• 16. Lim A, Song Y. The role of psychological insulin resistance in diabetes self-care management. Nurs Open. 2020;7(3):887-894. https://doi.org/10.1002/nop2.455
• 17. Okazaki K, Shingaki T, Cai Z, Perez-Nieves M, Fisher L. Successful healthcare provider strategies to overcome psychological insulin resistance in Japanese patients with type 2 diabetes. Diabetes Ther. 2019;10(6):1823-1834. https://doi.org/10.1007/s13300-019-00689-w
• 18. Fu CH, Lee LY, Huang LC, Tsay SL, Chen SC. Psychological insulin resistance and its impact on self-management in type II diabetes mellitus patients treated with insulin therapy. Int J Nurs Pract. 2024;30(2):e13190. https://doi.org/10.1111/ijn.13190
• 19. Jiang H, Wang Z, Liu K, et al. Influencing factors of psychological insulin resistance among patients with type 2 diabetes: a systematic review and meta-analysis. J Diabetes Metab Disord. 2025;24(2):201. https://doi.org/10.1007/s40200-025-01714-5
• 20. Rita SL, Lubaki FJ, Bompeka LF, Ogunbanjo GA, Ngwala LP. Prevalence and determinants of psychological insulin resistance among type 2 diabetic patients in Kinshasa. Afr J Prim Health Care Fam Med. 2019;11(1):e1-e5. https://doi.org/10.4102/phcfm.v11i1.1829
• 21. Yu JH, Kim HY, Kim SR, Ko E, Jin HY. Factors influencing psychological insulin resistance in type 2 diabetes patients. Int J Nurs Pract. 2019;25(3):e12733. https://doi.org/10.1111/ijn.12733
• 22. Polonsky WH, Fisher L, Hessler D, et al. Identifying solutions to psychological insulin resistance: an international study. J Diabetes Complications. 2019;33(4):307-314. https://doi.org/10.1016/j.jdiacomp.2018.12.005
• 23. Çevik Aktura S, Özden G. Psychological insulin resistance and affecting factors in patients with type 2 diabetes. J Hum Sci. 2022;19(4):510-520. https://doi.org/10.14687/jhs.v19i4.6493
• 24. Gül Ş, Duru Aşiret G, Okatan C. Examination of fear of hypoglycemia in individuals with type 2 diabetes mellitus. Dokuz Eylül Üniversitesi Hemşirelik Fakültesi Elektron Derg. 2021;14(3):179-187. https://doi.org/10.46483/deuhfed.825712
• 25. Sakane N, Kotani K, Tsuzaki K, et al. Fear of hypoglycemia and its determinants in insulin-treated patients with type 2 diabetes mellitus. J Diabetes Investig. 2015;6(5):567-570. https://doi.org/10.1111/jdi.12339
• 26. Song Y. Concept analysis for psychological insulin resistance in Korean people with diabetes. J Korean Acad Nurs. 2016;46(3):443-453. https://doi.org/10.4040/jkan.2016.46.3.443
• 27. Jang YJ. Psychological insulin resistance: key factors and intervention. J Korean Diabetes. 2021;22(3):192-196. https://doi.org/10.4093/jkd.2021.22.3.192
• 28. Cox DJ, Irvine A, Gonder-Frederick L, Nowacek G, Butterfield J. Fear of hypoglycemia: quantification, validation, and utilization. Diabetes Care. 1987;10(5):617-621. https://doi.org/10.2337/diacare.10.5.617
• 29. Yekefallah L, Moradi M, Javadi M, Alizade A, Mafi MH. Relationship between fear of hypoglycemia and spiritual well-being in people with type 2 diabetes: a single center study. Clin Diabetol. 2023;12(2):87-94. https://doi.org/10.5603/DK.a2023.0012
• 30. Lamounier RN, Geloneze B, Leite SO, et al. Hypoglycemia incidence and awareness among insulin-treated patients with diabetes: the HAT study in Brazil. Diabetol Metab Syndr. 2018; 10:83. https://doi.org/10.1186/s13098-018-0384-8
• 31. Yuksel M, Bektas H. Compliance with treatment and fear of hypoglycaemia in patients with type 2 diabetes. J Clin Nurs. 2021;30(13-14):1773-1786. https://doi.org/10.1111/jocn.15736
• 32. Bozdoğan Yeşilot S, Yeşil Demirci P, Eskimez Z. Hypoglycemia fear and psychological resilience: effects on disease acceptance in type II diabetes. Turk J Fam Med Prim Care. 2025;19(1):83-90. https://doi.org/10.21763/tjfmpc.1423955
• 33. Hapunda G, Abubakar A, Pouwer F, et al. Correlates of fear of hypoglycemia among patients with type 1 and 2 diabetes mellitus in Zambia. Int J Diabetes Dev Ctries. 2020; 40:619-626. https://doi.org/10.1007/s13410-020-00835-2
• 34. Türen S, Yılmazer R. The relationship between fear of hypoglycemia and health-related quality of life in diabetic patients with heart disease. Eur Rev Med Pharmacol Sci. 2023;27(4):1515-1523. https://doi.org/10.26355/eurrev_202302_31189
• 35. Bitsang E, Tsima BM, Motlhatlhedi K. Psychological insulin resistance among patients with diabetes mellitus in Botswana. Afr J Prim Health Care Fam Med. 2025;17(1):1-7. https://doi.org/10.4102/phcfm.v17i1.4642
• 36. Gulam AH, Otieno FC, Omondi-Oyoo G. Prevalence of psychological insulin resistance among patients with type 2 diabetes at Kenyatta National Hospital, Kenya. Health Sci J. 2017;11(3):1. https://doi.org/10.21767/1791-809X.1000508
• 37. Allen NA, Zagarins SE, Feinberg RG, Welch G. Treating psychological insulin resistance in type 2 diabetes. J Clin Transl Endocrinol. 2017; 7:1-6. https://doi.org/10.1016/j.jcte.2016.12.001
• 38. 38NS, Bükün MF, Köse Ö. Kaygı ve korkunun işlevsel olan ve olmayan taraflarına genel bir bakış. Bingöl Üniversitesi Sosyal Bilimler Enstitüsü Dergisi. 2022; 24:653-666. https://doi.org/10.29029/busbed.1165560
• 39. Rossi MC, Nicolucci A, Ozzello A, et al. Impact of severe and symptomatic hypoglycemia on quality of life and fear of hypoglycemia in type 1 and type 2 diabetes: results of the Hypos-1 observational study. Nutr Metab Cardiovasc Dis. 2019;29(7):736-743. https://doi.org/10.1016/j.numecd.2019.03.005
• 40. Li S, Li Y, Zhang L, et al. Impact of fear of hypoglycaemia on self-management in patients with type 2 diabetes mellitus: structural equation modelling. Acta Diabetol. 2022;59(5):641-650. https://doi.org/10.1007/s00592-021-01796-2
• 41. Grammes J, Schäfer M, Benecke A, et al. Fear of hypoglycemia in patients with type 2 diabetes: the role of interoceptive accuracy and prior episodes of hypoglycemia. J Psychosom Res. 2018;105:58-63. https://doi.org/10.1016/j.jpsychores.2017.11.008
• 42. Bohme P, Bertin E, Cosson E, et al. Fear of hypoglycaemia in patients with type 1 diabetes: do patients and diabetologists feel the same way? Diabetes Metab. 2013;39(1):63-70. https://doi.org/10.1016/j.diabet.2012.09.004
• 43. Aleali AM, Payami SP, Latifi SM, Yazdanpanah L, Hesam S, Khajeddin N. Evaluation of psychological resistance to insulin treatment in type II diabetic patients. Diabetes Metab Syndr. 2018;12(6):929-932. https://doi.org/10.1016/j.dsx.2018.05.007
• 44. Gherman A, Veresiu IA, Sassu RA, Schnur JB, Scheckner BL, Montgomery GH. Psychological insulin resistance: a critical review of the literature. Pract Diabetes Int. 2011;28(4):125-128. https://doi.org/10.1002/pdi.1574
• 45. Selinger CP, Lal S, Eaden J, et al. Better disease specific patient knowledge is associated with greater anxiety in inflammatory bowel disease. J Crohns Colitis. 2013;7(6):e214-e218. https://doi.org/10.1016/j.crohns.2012.09.014