medwireNews: Fluctuations in blood glucose levels during the night can adversely impact the psychologic and physical function of people with type 1 diabetes during the following day, report researchers.
“People who have type 1 [diabetes] tell us that overnight blood sugars impact their function the following day, but we don’t have good data to support this and really understand in what ways function is impacted,” such as “which blood glucose variables matter” and “which aspects of function are affected,” explained presenting researcher Elizabeth Pyatak (University of Southern California, Los Angeles, USA) at the 82nd ADA Scientific Sessions in New Orleans, Louisiana.
To investigate this further, Pyatak and colleagues recruited 127 adults, aged 41 years on average, with type 1 diabetes to take part in their study – FEEL-T1D. The participants, 54% of whom were women, came from a range of different ethnicities. They were asked to wear a blinded continuous glucose monitor and an accelerometer to measure activity for 10–14 days.
The team looked at three key variables of overnight blood glucose: time below 70 mg/dL (3.9 mmol/L); time above 250 mg/dL (13.9 mmol/L); and overnight variability in blood glucose.
They then ascertained the impact of these key variables on measures of function, such as cognitive measures of sustained attention and perceptual speed; daily step count; self-reported fatigue; task performance; and net activity demand, based on survey responses and the outcomes of cognitive tasks completed 5–6 times a day. Overall, surveys were completed around 90% of the time.
The team found that more time spent with glucose levels below 70 mg/dL (3.9 mmol/L) was significantly associated with participants having poorer sustained attention the next day, whereas more time spent with glucose levels above 250 mg/dL (13.9 mmol/L) significantly predicted greater fatigue and a moderately lower step count.
Greater overnight variability in blood glucose had the greatest impact on function the next day, Pyatak noted, and was significantly associated with poorer sustained attention, increased fatigue, and less engagement in demanding daily activities.
“I think it’s really important to emphasize these were small effect sizes, but we’re talking about something that happens every single day for the rest of a person’s life,” said Pyatak. “So, I think it's important to pay attention to how these blood glucose changes are impacting function on a daily basis, even if it’s just a small decrement in function.”
She acknowledges that the study was small and that replication would help validate the findings further, but added: “As we move increasingly to more automated insulin delivery, how can these algorithms be most supportive of people’s mood and function, wellbeing, and day-to-day life?”
She concluded: “One of those things that we now know is that minimizing variability overnight is probably going to have the best impact on how people feel.”
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