Assessing thoughts, feelings and behaviours related to hypoglycaemia: Psychometric evaluation of the Hypoglycaemia Cues Questionnaire (HypoC-Q)

AIMS: To describe the design and examine the psychometric properties of the Hypoglycaemia Cues Questionnaire (HypoC-Q) for assessing thoughts, feelings, and behaviours related to hypoglycaemia among adults with type 1 diabetes (T1D).

METHODS: The HypoC-Q was designed iteratively, informed by exploratory interviews with 17 adults with T1D with impaired awareness of hypoglycaemia and/or recurrent severe hypoglycaemia, and consultation with diabetologists. Psychometric analyses were completed on baseline data from the Hypo-METRICS study. Data from adults with T1D, reporting at least one hypoglycaemic event, were eligible if they had completed the baseline HypoC-Q. Completion rates, latent structure, internal consistency, construct and known-groups validity were examined.

RESULTS: In Hypo-METRICS, 154 participants (62% females; mean ± SD age 44 ± 15 years; T1D duration: 23 ± 16 years) were eligible. All completed all 40 HypoC-Q items, demonstrating its acceptability. Exploratory factor analysis identified four scales with satisfactory internal consistency (α = 0.69-0.81): 1) low concern (7 items), 2) burnout (6 items), 3) missing cues (5 items), and 4) delaying treatment (9 items); plus eight items, treated separately. Construct validity was supported by significant moderate correlations between 'burnout' and fear of hypoglycaemia and diabetes distress, and between 'missing' and 'delay' with impaired awareness of hypoglycaemia; all three distinguished between those with intact and impaired awareness (known-groups validity); but not by history of severe hypoglycaemia.

CONCLUSIONS: The HypoC-Q is an acceptable, valid, and reliable measure of thoughts, feelings, and behaviours related to hypoglycaemia among adults with T1D. It is available for informing and assessing the effect of interventions to reduce hypoglycaemia exposure and impact.