Fear of Nighttime Hypoglycemia: Perspectives of Diabetes Providers and Caregivers.

Nighttime hypoglycemia is a significant concern for caregivers of youth with type 1 diabetes (T1D), often leading to persistent worry and compensatory behaviors that maintain elevated nighttime glucose levels. In the present study, we qualitatively assessed specific fears related to nighttime hypoglycemia and behaviors to avoid nighttime hypoglycemia from caregivers of youth with T1D. In addition, we interviewed diabetes providers to assess if these topics are discussed in diabetes clinic. We completed semi-structured interviews with 10 diabetes providers and 15 caregivers. We used Framework Matrix Analysis theory to assess specific qualitative patterns. We identified 40 a priori codes and uncovered 3 de novo codes, which fit into 18 subthemes across three core themes: (1) specific fears about nighttime hypoglycemia, (2) caregiver behaviors to prevent it, and (3) negative outcomes stemming from these fears and behaviors. Both caregivers and providers acknowledged the prevalence of nighttime hypoglycemia, anxiety, and its potential impact on family well-being. These findings underscore the importance of addressing caregiver fears in clinical care, particularly for families managing frequent hypoglycemia or elevated nighttime glucose levels. Routine screening for fear-driven behaviors may help improve both caregiver and child outcomes.