目的:糖尿病困扰是1型和2型糖尿病患者中最常见的心理健康问题之一。关于血糖控制作为糖尿病困扰的潜在因素的作用以及对血糖控制的主观感知或客观血糖参数是否对经验更重要,人们知之甚少。随着连续血糖监测(CGM)的出现,这是一个相关的问题,因为葡萄糖值现在是实时可见的。我们采用了精确的监测方法来分析每天感知和测量的血糖控制与糖尿病困扰的独立关联。通过使用n-of-1分析,我们的目的是在3个月的随访中确定每个人的糖尿病困扰的个体因素,并分析这些个体因素与心理健康的关联.
方法:在此前瞻性中,观察性研究,感知(低血糖/高血糖/葡萄糖变异性负担)和测量的葡萄糖控制(低血糖和高血糖的时间,CV)使用特殊的EMA应用程序和CGM进行生态瞬时评估(EMA)方法每天评估17天,分别。进行了混合效应回归分析,以每日糖尿病困扰为因变量,每日感知和CGM测量的血糖控制指标为随机因素。在3个月的随访中,每日困扰与感知和CGM测量指标的个体回归系数与社会心理健康水平相关。
结果:分析了379名参与者的数据(50.9%的1型糖尿病;49.6%的女性)。感知的血糖变异性(t=14.360;p<0.0001)和感知的高血糖(t=13.637;p<0.0001)是每日糖尿病困扰的最强预测因子,而基于CGM的血糖变异性没有显着相关(t=1.070;p=0.285)。在感知和测量的葡萄糖参数与糖尿病困扰的关联中,个体之间存在很大的异质性。在感知血糖控制和每日痛苦之间有更强关联的个体有更多的抑郁症状(β=0.32)。随访时的糖尿病困扰(β=0.39)和低血糖恐惧(β=0.34)(所有p<0.001)。在CGM测量的血糖控制与日常困扰之间具有更强关联的个体在随访时的社会心理健康水平较高(抑郁症状:β=-0.31;糖尿病困扰:β=-0.33;低血糖恐惧:β=-0.27;所有p<0.001),但HbA1c也较高(β=0.12;p<0.05)。
结论:总体而言,与血糖控制的客观CGM参数相比,对血糖的主观认知对糖尿病困扰的影响更大.N-of-1分析表明,CGM测量和感知的血糖控制与3个月后的糖尿病困扰和社会心理健康有不同的关联。结果强调需要了解糖尿病困扰的个体驱动因素,以便在精确的心理健康方法中开发个性化干预措施。
OBJECTIVE: Diabetes distress is one of the most frequent mental health issues identified in people with type 1 and type 2 diabetes. Little is known about the role of glucose control as a potential contributor to diabetes distress and whether the subjective perception of glucose control or the objective glycaemic parameters are more important for the experience. With the emergence of continuous glucose monitoring (CGM), this is a relevant question as glucose values are now visible in real-time. We employed a precision monitoring approach to analyse the independent associations of perceived and measured glucose control with diabetes distress on a daily basis. By using n-of-1 analyses, we aimed to identify individual contributors to diabetes distress per person and analyse the associations of these individual contributors with mental health at a 3 month follow-up.
METHODS: In this prospective, observational study, perceived (hypoglycaemia/hyperglycaemia/glucose variability burden) and measured glucose control (time in hypoglycaemia and hyperglycaemia, CV) were assessed daily for 17 days using an ecological momentary assessment (EMA) approach with a special EMA app and CGM, respectively. Mixed-effect regression analysis was performed, with daily diabetes distress as the dependent variable and daily perceived and CGM-measured metrics of glucose control as random factors. Individual regression coefficients of daily distress with perceived and CGM-measured metrics were correlated with levels of psychosocial well-being at a 3 month follow-up.
RESULTS: Data from 379 participants were analysed (50.9% type 1 diabetes; 49.6% female). Perceived glucose variability (t=14.360; p<0.0001) and perceived hyperglycaemia (t=13.637; p<0.0001) were the strongest predictors of daily diabetes distress, while CGM-based glucose variability was not significantly associated (t=1.070; p=0.285). There was great heterogeneity between individuals in the associations of perceived and measured glucose parameters with diabetes distress. Individuals with a stronger association between perceived glucose control and daily distress had more depressive symptoms (β=0.32), diabetes distress (β=0.39) and hypoglycaemia fear (β=0.34) at follow-up (all p<0.001). Individuals with a stronger association between CGM-measured glucose control and daily distress had higher levels of psychosocial well-being at follow-up (depressive symptoms: β=-0.31; diabetes distress: β=-0.33; hypoglycaemia fear: β=-0.27; all p<0.001) but also higher HbA1c (β=0.12; p<0.05).
CONCLUSIONS: 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.