Mean Levels and Variability in Affect, Diabetes Self-Care Behaviors, and Continuously Monitored Glucose: A Daily Study of Latinos With Type 2 Diabetes

Abstract

Objective This study investigated between-person and within-person associations among mean levels and variability in affect, diabetes self-care behaviors, and continuously monitored glucose in Latinos with type 2 diabetes. Methods Fifty participants (mean age=57.8 [SD=11.7] years, 74% women, mean A1c=8.3% [SD=1.5%]) wore a “blinded” continuous glucose monitor for 7 days, and they responded to twice-daily automated phone surveys regarding positive affect (PA), negative affect (NA) and self-care behaviors. Results Higher mean levels of NA were associated with higher mean glucose (r=.30), greater % hyperglycemia (r = .34) and greater % out of range glucose (r = .34). Higher NA variability was also related to higher mean glucose (r = .34), greater % hyperglycemia (r = .44) and greater % out-of-range glucose (r = .43). Higher PA variability was related to lower % hypoglycemia (r = −.33). Higher mean levels of self-care behaviors were related to lower glucose variability (r = −.35). Finally, higher self-care behavior variability was related to greater % hyperglycemia (r =.31) and greater % out-of-range glucose (r =−.28). In multilevel regression models, within-person increases from mean levels of self-care were associated with lower mean levels of glucose (b = −7.4, 95% CI: −12.8 to -1.9), lower % hyperglycemia (b = −.04, 95% CI: −.07 to −.01), and higher % hypoglycemia (b = .02, 95% CI: .01 to .03) in the subsequent 10-hour period. Conclusions Near-to-real time sampling documented associations of glucose with affect and diabetes self-care that are not detectable with traditional measures.

Glucose variability and mood in adults with diabetes: A systematic review

“…Overall, the results of this systematic review do not provide clear evidence for a link between intraday GV and mood states in adults with diabetes 19,20,24,25 . A significant association was found between a higher rate of postprandial glucose increase and more negative mood symptoms in persons with type 2 diabetes, 22,23 warranting further research.…”

“…Five studies were conducted in North America 20,22‐25 and three in Europe 18,19,21 . Research designs were observational (n = 5), 18,19,24‐26 crossover randomized controlled trials (n = 2) 21,22 and experimental (n = 1) 20 . Details of the study design and participant characteristics are shown in Table 1.…”

“…One study used a glucose/insulin infusion procedure allowing for continuous measurement of blood glucose similar to CGM 20 . Five studies measured intraday GV, 19,20,22‐24 two studies measured GV over multiple days, 18,21 and one study captured intraday GV as well as over one week 25 . The GV metrics used as described by Siegelaar et al 15 were the standard deviation (SD), with time windows ranging from 10 hours up to four weeks, 18,21,24,25 coefficient of variation (CV) 19 and continuous overall net glycaemic action (CONGA) 24 .…”

“…Again, Penckofer et al 24 did not observe a significant association between GV and depressive symptoms in persons with type 2 diabetes. Wagner et al 25 determined the correlation between positive or negative mood and GV, measured with the CV, of the 10‐hour period following the mood rating, and found no significant association.…”

“…Second, with regard to measuring mood, half of the studies used retrospective questionnaires, 18,21,24,25 which are more prone to recall bias than momentary assessments, 28 and are less sensitive to mood fluctuations within one day. Preferably, mood is assessed in a time window close to the measurement of GV, that is fluctuations in glucose values that occur throughout a reasonable time period of interest 15 .…”