medwireNews: Researchers have found that the early morning psychosocial state of adolescents and young adults with type 1 diabetes explains a proportion of their daily variance in time in range (TIR).
Given that young people with diabetes “contend with their condition on an hour-by-hour, day-by-day basis, understanding the context for these patterns is essential,” say Laurel Messer (University of Colorado Anschutz Medical Campus, Aurora, USA) and study co-authors.
“The variability in mean glycemia and adherence behaviours, coupled with new morning predictors of this variability, could yield an impactful new intervention target for further study.”
The study included 88 participants aged between 14 and 26 years (average age 17.6 years, 54% female). The researchers highlight the “clinically significant” intra-individual variability in daily glucose control during the 2-week study period; TIR varied by an average of 16 percentage points and average sensor glucose level by 30.4 mg/dL (1.68 mmol/L).
The young people’s attention to bolusing also fluctuated, with the number given per day, varying by an average of 2.2.
“In clinical care, glycemic data are generally analyzed as aggregate, usually using 14 days of data to determine mean glucose level and TIR via the ambulatory glucose profile,” write the researchers in Diabetic Medicine.
They say intra-person variability in glucose control observed in this study “is obscured by typical aggregate metrics, yet easily obtainable from [continuous glucose monitoring] devices.”
On 6 “quasi-random” days within a 2-week period, the participants completed an engagement prediction survey and set a diabetes management goal for the day when they woke up, and also completed an evening survey to gauge their perceived effort, planning, and attainment in relation to that goal.
The engagement prediction survey included 25 questions measuring 10 factors that could influence diabetes management. They included questions on physiologic variables (glucose level, sleep duration), mood, motivation, control beliefs, social support, stress, general health, self-esteem, and perceived need for assistance.
In all, seven items on the morning engagement survey collectively explained 16.7% of the day-to-day variability in TIR. These were:
- current glucose level;
- planning to manage diabetes;
- desire to manage diabetes;
- wish to skip self-management activities because of feeling fine;
- feeling good about oneself;
- perception of general health; and
- perception for need of support.
These items also explained 18.6% of the daily variability in average glucose levels and 28.7% of the variability in daily goal attainment, but just 2.1% of the variability in the number of insulin boluses given.
Of note, lower morning glucose levels correlated with measures of good sleep, high motivation, and good health, whereas higher morning glucose levels were associated with illness and feeling the need for support.
The researchers concede that the effect size of the items identified in this study is “modest,” but stress that “it is novel to find psychological and emotional predictors for a physiological outcome such as mean glycemia.”
They conclude: “Routinely assessing these factors could be used to identify days when [adolescents and young adults] are at higher risk for self-management difficulties.”
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Diabet Med 2022; doi:10.1111/dme.14910