Gonder-Frederick Linda A, Grabman Jesse H, Kovatchev Boris, Brown Sue A, Patek Stephen, Basu Ananda, Pinsker Jordan E, Kudva Yogish C, Wakeman Christian A, Dassau Eyal, Cobelli Claudio, Zisser Howard C, Doyle Francis J
Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA Behavioral Medicine Center, University of Virginia, Charlottesville, VA, USA
Behavioral Medicine Center, University of Virginia, Charlottesville, VA, USA.
J Diabetes Sci Technol. 2016 May 3;10(3):640-6. doi: 10.1177/1932296816635199. Print 2016 May.
The relationship between daily psychological stress and BG fluctuations in type 1 diabetes (T1DM) is unclear. More research is needed to determine if stress-related BG changes should be considered in glucose control algorithms. This study in the usual free-living environment examined relationships among routine daily stressors and BG profile measures generated from CGM readings.
A total of 33 participants with T1DM on insulin pumps wore a CGM device for 1 week and recorded daily ratings of psychological stress, carbohydrates, and insulin boluses.
Within-subjects ANCOVAs found a significant relationship between daily stress and indices of BG variability/instability (r = .172 to .185, P = .011 to .018, r(2) = 2.97% to 3.43%), increased % time in hypoglycemia (r = .153, P = .036, r(2) = 2.33%) and decreased carbohydrate consumption (r = -.157, P = .031, r(2) = 2.47%). Models accounted for more variance for individuals reporting the highest daily stress. There was no relationship between stress and mean daily glucose or low/high glucose risk indices.
These preliminary findings suggest that naturally occurring daily stressors can be associated with increased glucose instability and hypoglycemia, as well as decreased food consumption. In addition, findings support the hypothesis that some individuals are more metabolically reactive to stress. More rigorous studies using CGM technology are needed to understand whether the impact of daily stress on BG is clinically meaningful and if it is a behavioral factor that should be considered in glucose control systems for some individuals.
1型糖尿病（T1DM）患者日常心理压力与血糖波动之间的关系尚不清楚。需要更多研究来确定在血糖控制算法中是否应考虑与压力相关的血糖变化。本研究在日常自由生活环境中，探讨了日常常规应激源与连续血糖监测（CGM）读数生成的血糖谱测量值之间的关系。
共有33名使用胰岛素泵的T1DM患者佩戴CGM设备1周，并记录每日心理压力、碳水化合物摄入量和胰岛素推注量的评分。
受试者内协方差分析发现，日常压力与血糖变异性/不稳定性指标之间存在显著关系（r = 0.172至0.185，P = 0.011至0.018，r² = 2.97%至3.43%），低血糖时间百分比增加（r = 0.153，P = 0.036，r² = 2.33%），碳水化合物摄入量减少（r = -0.157，P = 0.031，r² = 2.47%）。模型对报告每日压力最高的个体解释的方差更多。压力与每日平均血糖或低血糖/高血糖风险指标之间没有关系。
这些初步研究结果表明，自然发生的日常应激源可能与血糖不稳定性增加、低血糖以及食物摄入量减少有关。此外，研究结果支持了一些个体对压力代谢反应更强的假设。需要使用CGM技术进行更严格的研究，以了解日常压力对血糖的影响在临床上是否有意义，以及它是否是一些个体血糖控制系统中应考虑的行为因素。
