Fear of hypoglycemia and disordered eating behavior in type 1 diabetes

Individuals with type 1 diabetes (T1D) are at elevated risk for disordered eating behaviors (DEBs). When DEBs occur in someone with T1D, they have severe consequences, including increased risk of diabetes-related medical complications and early mortality related to poor glycemic control. Fear of hypoglycemia (FoH) is a diabetes-specific factor that is assumed to play a role in DEBs in T1D, but this has not been adequately tested. The current study examined FoH as a predictor of DEBs in the natural environment in adults with T1D who met criteria for clinically significant DEBs. Participants (n = 59) completed the 18 item FoH worry subscale of the Hypoglycemia Fear Survey II and reported on their eating behavior over three days of ecological momentary assessment. A total of 737 eating episodes were reported; 235 (31.89%) eating episodes involved DEBs (overeating or binge eating). The proportion of eating episodes that involved DEBs was regressed on FoH, controlling for age. Every one-point increase in the FoH worry subscale score was associated with a 2% increase in the odds of DEB (OR = 1.02; 95% CI [1.01, 1.03], p < .001). Results suggest that FoH may be an important clinical factor when addressing DEBs in T1D.