Design and development of a scale measuring fear of complications in type 1 diabetes

There are many determinants of glycaemic control in patients with type 1 diabetes. Patients with type 1 diabetes and poor glycaemic control have been reported as being more likely to have a greater fear of hypoglycaemia. The relationship between fear of diabetes-related complications and glycaemic control is unclear, and therefore a brief measure of fear of diabetes complications was developed.

A questionnaire was designed, comprising items relating to general fears, specific fears (e.g. blindness, kidney problems, heart disease), lifestyle fears, fear of hypoglycaemia and weight gain. The questionnaire was piloted on 147 outpatients with type 1 diabetes, along with other measures such as the Hypoglycaemia Fear Survey, the Hospital Anxiety and Depression Scales, the Coping with Health, Injuries and Problems Scale and the Eysenck Personality Questionnaire.

Factor analysis was carried out on the 30 items and, after rotation, 15 emerged as loading heavily on the first factor. Factor analysis was rerun on these 15 items and the first factor accounted for 56% of the total variance. This factor remained invariant when the scale was split randomly and by age and gender. The reliability of the scale (alpha) was 0.94. The scale did not correlate with any demographic variables but did with measures of negative affectivity (HADS anxiety = 0.34, p < 0.001; Depression = 0.24, p < 0.004), the Hypoglycaemia fear survey worry Scale (0.44, p < 0.001), presence of complications (0.17, p < 0.04) and number of complications (0.28, p < 0.001).

These results indicate that the scale identifies a fear that is moderately related to the presence of complications and general negative affectivity but which is a uniquely diabetes-related emotion.