News | July 2019

dQ&A® Diabetes Research Shows Far-Reaching Mental, Emotional, and Physical Impact of Hypoglycemia

Research shows that millions of people with diabetes in the US don’t feel confident that they can stay safe while driving and are terrified about passing out in public due to severe hypoglycemia. Many engage in behaviors to avoid hypoglycemia that can be harmful to their health in the long-term.

SAN FRANCISCO, California, July 30, 2019 — dQ&A Market Research Inc., the leader in diabetes patient research, released selected results from its quarterly American research study of people with diabetes. The data show how the detrimental physical and mental impact of hypoglycemia extends far beyond episodes of low blood glucose.

The negative effects of hypoglycemia itself are clear—ranging from dizziness and headaches to confusion, unconsciousness, and (rarely) death—but in this study, dQ&A wanted to investigate how attitudes towards hypoglycemia impact people with diabetes. They asked 4,540 adults with diabetes to complete the Hypoglycemic Attitudes and Behavior Scale1, a 14-item self-reported scale that assesses hypoglycemia-related avoidance, anxiety, and confidence. Validated patient-reported outcome measures such as this are critical to understanding real-world efficacy and quality of life, and are becoming increasingly important to payers, regulators, and clinicians.

Alarmingly, one third of adults with diabetes—7.6 million people—don’t feel confident that they can stay safe from serious problems caused by hypoglycemia while driving. And among those taking insulin, one in five are “terrified” that they might pass out in public due to low blood glucose.

Concern about hypoglycemia not only harms mental well-being, but it can also cause people to adopt avoidance strategies that negatively impact their physical health. Unsurprisingly, this behavior is more common among people taking insulin. For example, nearly a third of people with type 1 diabetes and type 2 diabetes on insulin keep their blood glucose level “higher than [they] probably should” to avoid serious problems with low blood sugar. And a quarter say that if they think their blood sugar is too low, they’ll “start eating and eating and won’t stop until [they] feel better.” The resulting hyperglycemia, however, can lead to dangerous, debilitating, and costly complications in the long-term, including cardiovascular disease, diabetic nephropathy, retinopathy, and foot problems requiring amputation.

Percentage of all adults with diabetes Estimate of total people affected in the USA
Don’t feel confident about staying safe from serious problems with low blood sugar while driving 33% 7.6 million
Terrified about passing out in public due to a low blood sugar episode 13% 3.0 million
Tend to keep blood sugars higher than recommended to avoid serious problems with low blood sugar 17% 3.9 million


“This study highlights the widespread fear about hypoglycemia experienced by people with diabetes,” said Richard Wood, dQ&A’s CEO. “Beyond the negative impact this stress has on mental health, the associated behavior to avoid lows is a big factor preventing people from having better blood glucose control. These findings emphasize the importance of therapies that help people spend more time in range and feel confident about their ability to prevent and treat hypoglycemia.”

While insulin and sulfonylureas are linked to increased hypoglycemia avoidance behavior and anxiety in people with type 2 diabetes, as expected, there are also a number of individuals not taking these medicines who don’t feel confident about managing hypoglycemia and take action to avoid lows.

Hypoglycemic Attitudes and Behavior Scale Percentage of adults with type 2 diabetes
Insulin and sulfonylurea (n=231) Insulin, no sulfonylurea (n=725) No insulin, sulfonylurea (n=505) No insulin, no sulfonylurea (n=802)
High Avoidance Score 20% 24% 19% 11%
High Anxiety Score 12% 9% 6% 4%
Low Confidence Score 16% 14% 14% 13%

Note: All scores have a minimum of 1 and a maximum of 5. A high score for avoidance and anxiety is defined as a score >3. A low confidence score is defined as a score ≤3.

Among adults with type 1 diabetes, CGM use is associated with significantly less hypoglycemia-related anxiety and avoidance behavior, and higher levels of confidence.

Hypoglycemic Attitudes and Behavior Scale Percentage of adults with type 1 diabetes
CGM user (n=1,200) CGM non-user (n=335)
High Avoidance Score 21% 31%
High Anxiety Score 11% 17%
Low Confidence Score 16% 23%

Note: All scores have a minimum of 1 and a maximum of 5. A high score for avoidance and anxiety is defined as a score >3. A low confidence score is defined as a score ≤3.

This study underscores the importance of increasing access to existing medicines and devices that help people prevent and manage hypoglycemia, and feel confident in their ability to do so. It’s also clear that there is a need for better tools to help people spend more time in the ideal blood glucose range, and reduce the anxiety associated with hypoglycemia.

Please contact dQ&A’s CEO Richard Wood at for more information about this piece of research, or for inquiries into dQ&A’s industry-leading services.

dQ&A would like to express its sincere gratitude to all of the community members who participated in this research study.

  1. The Hypoglycemic Attitudes and Behavior Scale is copyrighted by the Behavioral Diabetes Institute.


About dQ&A – The Diabetes Research Company

dQ&A is a social enterprise that’s committed to making life better for people with diabetes. We harness patient voices to help develop better products, services and policies, answer key business questions and improve health outcomes for people with diabetes. For ten years, we have focused exclusively on understanding what life is like for those with diabetes. We are trusted by patients because of our independence and commitment to them. And we are endorsed by industry leaders because we deliver high quality answers quickly and efficiently, through the use of our proprietary community. Our team has decades of experience in quantitative and qualitative research and a deep knowledge of diabetes. Many of our lives have been touched by diabetes, so we have a personal stake in our work.

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