Background & Aims

Pain in diabetic neuropathy and psychological aspects associated with the chronic treatment of diabetes mellitus (DM) have a major impact on patients’ quality of life. The fear of hypoglycemia (specific phobia) can lead cognitively to anxiety and depression, and behaviorally to an attempt to keep blood sugar disproportionately high. Therefore, we wanted to investigate the differences in fear of hypoglycemia in the DM group with and without pain and its relationship to anxiety and depression.

Methods

N=34 patients with DM (92% DM1 and 8% DM2), a total of 56% of the subjects were male, with average age=44.23 (min 20-77 max), length of education=14.88 (min 10-21max), duration of illness=17.81 years (min3-48max), with average HbA1c=7.41 (min 2.20-14.50max), from which 38.20% used insulin pumps, was psychologically assessed at the Center for Diabetology, Internal Dpt of the 3rd Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady,Prague. Patients were divided according to the presence of pain in the visual analog scale (VAS), 50% of patients (n=17) had neuropathic peripheral pain with its average intensity 4.90 (VAS min 1.70-8.40 max), 50% of patients (n=17) had no pain. They filled out the questionnaires that determined the degree of neuropathic pain (Neuropathic Pain Symptom Inventory,NPSI), fear of hypoglycemia (HFS-II), depression (BDI-II) and anxiety (GAD-7). Non-parametric tests (Kruskal–Wallis, Spearman’s r) were performed for statistic processing.

Results

The NPSI neuropathic pain measure differed bordeline significantly between groups, (X2) =3.7203, p=.0504: the pain group score was found to be higher (Me= 15.30) than the no pain group score (Me = 3.17). Fear of hypoglycemia (HFS-II) was significantly different between groups, (X2) = 3.6711, p=0.0500): it was found that the score of the pain group was higher (Me= 42.00) than the score of the no-pain group (Me = 16.00). The level of HbA1c did not reach significant differences between groups, (X2)= 0.4516, p= 0.5016, although it was found that the score of the pain group was higher (Me= 8.50) than the score of the no-pain group (Me=7.00 ). Fear of hypoglycemia (HFS-II) correlates significantly strongly positive with depression rs= 0.7304, p= <.0001 and with anxiety rs= 0.6189, p= <.0001. Depression can explain 56% (R2 =0.557) and anxiety 47% (R2=0.468) of the variability of fear of hypoglycemia (HFS-II) in this clinical group.

Conclusions

Diabetes mellitus (DM) patients with neuropathic pain who have a great fear of hypoglycemia may be at risk of developing other anxiety and depressive comorbidities due to the loss of control over the disease and thus lack of motivation for treatment.
Therefore, the comprehensive treatment of these patients with DM should also include evidence-based psychotherapeutic approaches such as cognitive-behavioral therapy (CBT), and acceptance and commitment therapy (ACT) with mindfullness therapy (MT).

The study was supported by Cooperatio 37 a MH CZ – DRO (“Kralovske Vinohrady University Hospital – FNKV, 00064173”).

References

Bai, Y., Ma, J.-H., Yu, Y., & Wang, Z.-W. (2022). Effect of Cognitive-Behavioral Therapy or Mindfulness Therapy on Pain and Quality of Life in Patients with Diabetic Neuropathy: A Systematic Review and Meta-Analysis. Pain Management Nursing, 23(6), 861–870. https://doi.org/10.1016/j.pmn.2022.05.005
Bhat, N.A., Muliyala, K.P., Chaturvedi, S.K. (2020). Psychological Aspects of Diabetes. EMJ Diabet. 8(1),90-98. doi 10.33590/emjdiabet/20-00174
Davoudi, M., Taheri, A.A., Foroughi, A. et al. (2020). Effectiveness of acceptance and commitment therapy (ACT) on depression and sleep quality in painful diabetic neuropathy: a randomized clinical trial. J Diabetes Metab Disord, 19, 1081–1088 https://doi.org/10.1007/s40200-020-00609-x
Przezak, A., Bielka, W., & Mol?da, P. (2022). Fear of hypoglycemia-An underestimated problem. Brain and Behavior, 12(7), e2633. https://doi.org/10.1002/brb3.2633
Shi et al.: Is hypoglycemia fear independently associated with health-related quality of life? Health and Quality of Life Outcomes 2014 12:167. doi:10.1186/s12955-014-0167-3

Presenting Author

Jaroslava Raudenska

Poster Authors

Jaroslava Raudenska

PhD

2nd medical faculty of Charles University

Lead Author

Ludmila Brunerova

MD

Center for Diabetology, Internal Dpt of the 3rd Faculty of Medicine, Charles University

Lead Author

Jana Urbanova

MD

Center for Diabetology, Internal Dpt of the 3rd Faculty of Medicine, Charles University

Lead Author

Elena Silhova

MD

Center for Diabetology, Internal Dpt of the 3rd Faculty of Medicine, Charles University

Lead Author

Richard Sotornik

MD

Center for Diabetology, Internal Dpt of the 3rd Faculty of Medicine, Charles University

Lead Author

Katerina Westlake

MD

Center for Diabetology, Internal Dpt of the 3rd Faculty of Medicine, Charles University

Lead Author

Adam Ernest

MD

Dpt of Ophthalmology, University Hospital Kralovske Vinohrady and 3rd Faculty of Medicine, Prague

Lead Author

Alena Javurkova

University Hospital Motol

Lead Author

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Neuropathic Pain - Peripheral