263 ISSN 1758-1907 Diabetes Management (2014) 4(3), 263–271 REVIEW part of Diabetes Management 10.2217/DMT.14.3 © 2014 Future Medicine Ltd e K 3 REVIEW Assessing hyperglycemia avoidance in people with Type 1 diabetes D- Harsimran Singh* ,1 , Linda Gonder-Frederick 1 , Karen Schmidt 2 , Derek Ford 2 , Karen A Vajda 1 , Jefrey Hawley 1 & Daniel J Cox 1 1 Department of Psychiatry & Neurobehavioral Sciences, University of Virginia Health System, Charlottesville, VA, USA 2 Department of Psychology, University of Virginia, Charlottesville, VA, USA *Author for correspondence: Tel.: +1 434 982 1022; hs9dc@virginia.edu E SUMMARY: Aims: People with anxieties related to high blood glucose may engage in avoidance behaviors that increase their risk of hypoglycemia. Conversely, reduced concern about hyperglycemia could impair diabetes control. We developed the Hyperglycemia Avoidance Scale (HAS) to assess the extent of potentially problematic avoidant attitudes and behaviors in people with Type 1 diabetes (T1D). Materials & methods: The HAS was administered to 501 people with T1D (mean age: 43 years). Data analysis included Exploratory Factor Analysis (EFA) using polychoric correlations and Item Response Theory. Relationships between the HAS and other diabetes-related measures were examined. Results: The EFA supported a 22-item, four-factor solution with excellent item reliability for all factors. HAS factors were found to be predictive of prospective S Hand prospective driving mishaps. Higher HbA 1c values were also signifcantly related to the HAS. Pump users reported signifcantly greater avoidance of hyperglycemia than their counterparts. Conclusion: The HAS reliably quantifes afective and behavioral aspects of hyperglycemia avoidance. Future studies are encouraged to determine the usefulness of the scale with other more diverse populations with diabetes. Practice points ● Optimizing diabetes care involves maintaining the recommended metabolic levels while avoiding both hypoglycemia and hyperglycemia as much as possible. ● Fear of hypoglycemia is a well-established concern for people with diabetes using the insulin treatment. Clinical experience also supports that a few diabetes patients express extreme concern and avoidance behaviors linked to high blood glucose (BG) levels. Unfortunately however, the latter has not received adequate attention in the published literature. ● Patients with excessive concerns surrounding high BG levels could be a clinical challenge as they may attempt to keep BG lower than is clinically recommended for them, thereby increasing their risk for hypoglycemia. ● The Hyperglycemia Avoidance Scale (HAS) is a reliable and valid measure to help quantify the extent and impact of high BG-related concerns in a structured way. The measure includes 22 items overall, which are distributed across four subscales (immediate action, worry, low-BG preference and avoid extremes). ● Among other relevant fndings, study data showed that the HAS subscales were predictive of future episodes of severe hypoglycemia and driving mishaps. Higher HbA 1c values were also signifcantly related to the HAS. ● The HAS can be used as part of routine clinic consultations to help healthcare professionals better understand BG management in their patients and ofer opportunities for intervention if they fnd any extreme or abnormal concerns surrounding high BG levels.