Time with diabetes distress and how it relates to blood glucose levels

Research from Germany explores a new way to measure time in distress using ecological momentary assessment

By Ralph Geerling

Diabetes distress is the negative emotional response to living with and managing diabetes. It can affect overall well-being, relationships and quality of life. It can also affect how a person manages their diabetes and their glucose levels. Questionnaires can be used to assess diabetes distress. However, they ask people to reflect on how they feel right now (or over a two-week period), whereas it’s likely that diabetes distress changes from day-to-day, even from hour-to-hour.   

Researchers in Germany have conducted a study using a method called ‘ecological momentary assessments’ (or EMA). Put simply, this involves the people taking part in the study answering questions about their experiences or feelings several times a day, or at the same time every day for several days, in their own home. People usually use a smartphone to complete the questions.

The researchers asked about the burdens of self-care, the emotional toll of living with the condition and distress about glucose levels. Glucose levels were also recorded using a continuous glucose monitoring (CGM) device.

The aim of the study was to test how standard, one-off surveys about diabetes distress compare to the daily estimates, and how these relate to actual glucose levels.

Data were from 178 adults with type 1 diabetes who completed the daily questions (on at least 10 of the 17 days of the study) as well as the standard survey. Scores of ≥40 indicated higher levels of that type of distress. Data were collected in the year prior to the COVID-19 pandemic (i.e. before lockdown restrictions).

They found that participants spent:

    • 23% of their time with distress about low glucose levels
    • 55% of their time with distress about high glucose levels
    • 45% of their time with distress about changes in glucose levels
    • 24% of their time with distress about their glucose levels overall

The researchers also found that daily measurements of diabetes distress are more strongly associated with:

    • glucose levels (measured using CGM), than the standard surveys
    • HbA1c (three-monthly blood glucose average) taken at follow-up, than the standard surveys.

They concluded that daily measures of diabetes distress are more responsive to the day-to-day impact of managing diabetes and variations in glucose levels than traditional surveys. The researchers suggest further studies are needed on “in the moment” measures of diabetes distress.

The study can be accessed here: https://pubmed.ncbi.nlm.nih.gov/35613338/

For more about diabetes distress and how you can manage it, check out this blog or this NDSS factsheet

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