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Diabetes Mellitus · Journal article
Journal of Diabetes and Metabolic Disorders · August 27, 2026
Well-designed and adequately powered for the question it asks.
This meta-analysis of 13 observational studies demonstrates a significant negative association between fear of hypoglycemia and quality of life (r = -0.49) and a positive association with impaired sleep quality (r = 0.36) among individuals with diabetes. However, the predominance of cross-sectional designs and very high heterogeneity in the quality-of-life analysis substantially limit confidence in the pooled estimates and preclude determination of causality.
Systematic review and meta-analysis of observational studies. Studies of individuals with diabetes assessing fear of hypoglycemia in relation to quality of life and/or sleep quality. Intervention: Fear of hypoglycemia (FoH). Compared with: No FoH or low FoH (observational comparison within studies).
20 studies identified in systematic review; 13 included in meta-analysis Negative association between FoH and QoL: r = -0.49 (95% CI: -0.58 to -0.40; I² = 90.8%) Positive association between FoH and poorer sleep quality: r = 0.36 (95% CI: 0.28 to 0.44; I² = 70.4%)
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Clinicians should recognize that fear of hypoglycemia is associated with meaningfully reduced quality of life and sleep disruption in their patients with diabetes. However, the cross-sectional nature of the evidence means these associations may not be causal, and further longitudinal studies are needed to understand whether reducing fear of hypoglycemia would improve these outcomes.
A systematic review and meta-analysis of 13 observational studies with pooled correlation coefficients showing consistent negative associations between fear of hypoglycemia and quality of life (r = -0.49) and positive associations with sleep impairment (r = 0.36), though cross-sectional design and high heterogeneity preclude causal inference.
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Clinicians should recognize that fear of hypoglycemia is associated with meaningfully reduced quality of life and sleep disruption in their patients with diabetes. However, the cross-sectional nature of the evidence means these associations may not be causal, and further longitudinal studies are needed to understand whether reducing fear of hypoglycemia would improve these outcomes.
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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.
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