Journal of diabetes and metabolic disorders · 2026
Association between fear of hypoglycemia and quality of life and sleep quality among individuals with diabetes: a systematic review and meta-analysis of observational studies.
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Gentile Federico, Martino Marida, Santangelo Luisa, Giordano Paolo, Torres Diletta Domenica, Carbone Vincenza, Di-Palma Anna Maria, Rossini Michele, Gesualdo Loreto, Giordano Paola, Giordano Mario
Аннотация
BACKGROUND: Fear of hypoglycemia (FoH) is a prevalent psychological concern among individuals with diabetes and may adversely affect self-care behaviors, glycemic control, and emotional well-being. This systematic review and meta-analysis aimed to quantitatively evaluate the associations between FoH and both quality of life (QoL) and sleep quality among individuals with diabetes.
METHODS: In accordance with the PRISMA 2020 guidelines, a comprehensive literature search was conducted in PubMed, Embase, PsycINFO, CINAHL and Web of Science from database inception through June 26, 2026. Eligible studies were identified using the PECO-S framework (Population, Exposure, Comparison, Outcome, and Study Design). Two independent reviewers screened titles, abstracts, and full texts, with disagreements resolved through consultation with a third reviewer. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS). Pooled effect sizes were synthesized primarily from unadjusted (crude) correlation coefficients.
RESULTS: After screening 4,446 records, 20 studies were included in the systematic review, and 13 were included in the meta-analysis. Five studies assessed sleep quality, all of which were included in the meta-analysis, whereas eight studies assessed QoL, of which only four were eligible for quantitative synthesis. The pooled analysis showed a negative association between FoH and QoL (r = -0.49; 95% CI: -0.58 to -0.40; I² = 90.8%) and a positive association between FoH and poorer sleep quality (r = 0.36; 95% CI: 0.28 to 0.44; I² = 70.4%).
CONCLUSION: Fear of hypoglycemia was significantly associated with poorer quality of life and impaired sleep quality among individuals with diabetes. However, the very high heterogeneity observed in the quality-of-life analysis, together with the predominance of cross-sectional observational studies, limits confidence in the pooled estimates and precludes causal inference. Further well-designed longitudinal studies are warranted to clarify the temporal relationships.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at https://doi.org/10.1007/s40200-026-02057-5.
METHODS: In accordance with the PRISMA 2020 guidelines, a comprehensive literature search was conducted in PubMed, Embase, PsycINFO, CINAHL and Web of Science from database inception through June 26, 2026. Eligible studies were identified using the PECO-S framework (Population, Exposure, Comparison, Outcome, and Study Design). Two independent reviewers screened titles, abstracts, and full texts, with disagreements resolved through consultation with a third reviewer. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS). Pooled effect sizes were synthesized primarily from unadjusted (crude) correlation coefficients.
RESULTS: After screening 4,446 records, 20 studies were included in the systematic review, and 13 were included in the meta-analysis. Five studies assessed sleep quality, all of which were included in the meta-analysis, whereas eight studies assessed QoL, of which only four were eligible for quantitative synthesis. The pooled analysis showed a negative association between FoH and QoL (r = -0.49; 95% CI: -0.58 to -0.40; I² = 90.8%) and a positive association between FoH and poorer sleep quality (r = 0.36; 95% CI: 0.28 to 0.44; I² = 70.4%).
CONCLUSION: Fear of hypoglycemia was significantly associated with poorer quality of life and impaired sleep quality among individuals with diabetes. However, the very high heterogeneity observed in the quality-of-life analysis, together with the predominance of cross-sectional observational studies, limits confidence in the pooled estimates and precludes causal inference. Further well-designed longitudinal studies are warranted to clarify the temporal relationships.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at https://doi.org/10.1007/s40200-026-02057-5.