Diabetes is an emotionally stressful disease and its management is a daily challenge for patients. Blood sugar control plays a major role in this process, as DZD researchers have now been able to show. Their report in the specialist journal “Diabetologia” is as follows: Whether emotional stress leads to psychological problems such as depression apparently depends on whether the focus is on perceived or actually measured blood glucose control. 

The worries and fears associated with the challenging self-management of diabetes are summarized under the umbrella term “diabetes distress.” Diabetes distress is one of the most common mental health problems experienced by people with type 1 or type 2 diabetes.  

The role of blood glucose control in diabetes distress has been little researched to date. The question of whether the subjective perception of blood glucose control or objectively measured parameters have a greater influence on emotional stress has also hardly been investigated so far. But these questions are more relevant than ever. With the increasing use of continuous glucose monitoring (CGM) systems, patients can see their blood glucose levels at all times. 

Scientists from the Research Institute of the Diabetes Academy Bad Mergentheim (FIDAM), in collaboration with researchers from the DZD and partners from other institutions, investigated the influence of blood glucose control on the psychosocial well-being of 379 people with diabetes. 

Data collection via CGM system and smartphone app

For 17 days, the participants in the study wore a CGM system which measured the time spent in the hypo- and hyperglycemic range and the glucose variability on a daily basis. In a smartphone app, they also provided information on perceived blood glucose control – such as the perceived burden of hypoglycemia – and the emotional burden of diabetes. For example, the app asked participants every day how unable they felt to cope with their diabetes or how alone they felt in managing their diabetes. 

The evaluation of this information showed that the subjective perception of blood glucose control had a stronger effect on diabetes distress than the objective CGM parameters in all study participants. However, some patients placed their focus on perception and others on measuring blood glucose levels. And this subsequently had an impact on psychosocial well-being.  
 

© DZD

Trigger of diabetes distress determines risk for the psyche 

Participants whose diabetes distress was driven more by objective CGM parameters had fewer psychological problems at a follow-up appointment after 3 months, but a higher HbA1c value. In contrast, patients for whom perceived blood glucose control played a major role in diabetes distress reported more psychological problems after 3 months – more depressive symptoms, more diabetes distress and more fear of hypoglycemia. 

The researchers believe that knowledge of the individual drivers of diabetes distress could help to develop personalized support services to better help affected patients. 

Original-Publikation:
Dominic Ehrmann, Norbert Hermanns, Andreas Schmitt, Laura Klinker, Thomas Haak & Bernhard Kulzer. Perceived glucose levels matter more than CGM-based data in predicting diabetes distress in type 1 or type 2 diabetes: a precision mental health approach using n-of-1 analyses. Diabetologia 2024 Jul 30; doi: 10.1007/s00125-024-06239-9