Defining a Clinically Meaningful Cut-Point for the Hypoglycemia Fear Survey-Parents of Young Children.

Parents of young children with type 1 diabetes (T1D) frequently experience fear of hypoglycemia (FH) which contributes to higher child glucose. The Hypoglycemia Fear Survey-Parents of Young Children (HFS-PYC) is a validated questionnaire to assess parental FH, yet it lacks a clinically interpretable cut-point. We sought to identify a preliminary HFS-PYC cut-point that associates with higher parent anxiety, greater diabetes distress, and child glucose metrics. Parents (n=180) completed the HFS-PYC, PROMIS-Anxiety (PROMIS-A) and Problem Areas in Diabetes Parent-Revised (PAID-PR). We derived candidate cut-points using (a) modal score distribution (Mode), (b) mean + one standard deviation (SD), and (c) an elevated-item rule (EI). We compared groups above versus below each cut-point on PROMIS-A, PAID-PR, and child glycemic metrics. We calculated indices of diagnostic accuracy using PROMIS-A T-scores ≥60 as a reference. Candidate cut-points were ≥61 (Mode) and ≥77 (SD); EI required ≥5 of 9 items rated "Often/Almost Always." Prevalence of elevated FH ranged from 52% (Mode) to 18% (SD). All cut-points distinguished between parents with high versus low PROMIS-A and PAID-PR scores (p<0.001). Only the Mode cut-point differentiated among parents for some child glycemic metrics. The Mode cut-point also had the most favorable diagnostic accuracy (sensitivity=0.77, specificity=0.57) among the candidate cut-points. An HFS-PYC total score ≥61 identifies parents with greater anxiety and diabetes distress and children with higher glycemic metrics and shows the best diagnostic performance among candidate cut-points. Pending further validation, this preliminary cut-point may offer a practical starting point for clinical screening and research.