Perceived glucose levels matter more than continuous glucose monitoring (CGM)-based data in predicting diabetes distress in type 1 or type 2 diabetes: a precision mental health approach using n-of-1 analyses
Authors' conclusion
Overall, subjective perceptions of glucose seem to be more influential on diabetes distress than objective CGM parameters of glycaemic control. N-of-1 analyses showed that CGM-measured and perceived glucose control had differential associations with diabetes distress and psychosocial well-being 3 months later. The results highlight the need to understand the individual drivers of diabetes distress to develop personalised interventions within a precision mental health approach.
Study context
- Population
- People with T1D or T2D (50.9% T1D; 49.6% female); daily ecological momentary assessment (EMA) and CGM for 17 days, 3 month follow-up379 analysed
- Exposure
- Perceived vs CGM-measured glucose control as predictors of daily diabetes distress
- Outcome
- Daily diabetes distress, associations with perceived and CGM-measured glucose control
- Follow-up
- Daily for 17 days
Methodological detailsecological momentary assessment, n-of-1 analyses, mixed-effect regression
- Ecological momentary assessment
- n-of-1 analyses
- Mixed-effect regression
Main finding
As reported in the abstract
Perceived glucose variability
t=14.360
p<0.0001
Perceived hyperglycaemia
t=13.637
p<0.0001
CGM-based glucose variability, not significantly associated
t=1.070
p=0.285
Observational data: associations, not effects.
Further findings
Stronger individual association of perceived glucose control with daily distress vs psychosocial outcomes · 3 month follow-up
- More depressive symptoms
- β=0.32
- More diabetes distress
- β=0.39
- More hypoglycaemia fear
- β=0.34
- All p<0.001
Stronger individual association of CGM-measured glucose control with daily distress vs psychosocial outcomes · 3 month follow-up
- Depressive symptoms
- β=−0.31
- Diabetes distress
- β=−0.33
- Hypoglycaemia fear
- β=−0.27
- Higher HbA1c
- β=0.12; p<0.05
- Psychosocial outcomes all p<0.001; higher levels of psychosocial well-being
Original publication
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