<p>Fear of hypoglycemia may represent an important target for improving diabetes self-management among adolescents with T1DM. However, whether fear of hypoglycemia is associated with diabetes self-management remains undetermined, and the factors contributing to this uncertain association are poorly understood. This study aims to (1) examine the association between fear of hypoglycemia and diabetes self-management in Chinese adolescents with T1DM, and (2) explore potential mediators in this relationship. This muti-site cross-sectional study was conducted between January 2021 and December 2022 across three hospitals of China. Validated questionnaires assessed fear of hypoglycemia, depressive symptoms, diabetes distress and diabetes self-management. Two path analysis models were then conducted using Mplus 8.0 to test the mediating effects of diabetes distress and depressive symptoms on the relationship between fear of hypoglycemia and diabetes self-management in adolescents with T1DM. A total of 174 valid questionnaires were retained (effective response rate: 82.08%). Adolescents reported moderate fear of hypoglycemia was moderate (mean score = 14.04). Path analysis revealed that the mediating effect of diabetes distress between fear of hypoglycemia and diabetes self-management was significant(indirect effect: β = -0.165 and − 0,161, <i>p</i> = 0.001), whereas the mediating effect of depressive symptoms was not significant. Diabetes distress partially mediated the association between fear of hypoglycemia and diabetes self-management in adolescents with T1DM. Chinese adolescents with T1DM exhibited moderate fear of hypoglycemia. Diabetes distress partially mediated the relationship between fear of hypoglycemia and diabetes self-management, whereas depressive symptoms demonstrated no significant mediating effect in adolescents with T1DM. These findings suggest that interventions targeting diabetes distress reduction while maintaining fear of hypoglycemia at moderate levels may enhance diabetes self-management.</p>