Ozaslan Basak, Patek Stephen D, Grabman Jesse H, Shepard Jaclyn A, Dassau Eyal, Breton Marc D, Kudva Yogish C, Brown Sue A, Basu Ananda, Pinsker Jordan E, Doyle Francis J, Gonder-Frederick Linda
1 University of Virginia, Systems and Information Engineering, Charlottesville, VA, USA.
2 University of Virginia, Center for Diabetes Technology, Charlottesville, VA, USA.
J Diabetes Sci Technol. 2018 May;12(3):657-664. doi: 10.1177/1932296818758103. Epub 2018 Feb 8.
The objective was to investigate the relationship of body mass index (BMI) to differing glycemic responses to psychological stress in patients with type 1 diabetes.
Continuous blood glucose monitor (CGM) data were collected for 1 week from a total of 37 patients with BMI ranging from 21.5-39.4 kg/m (mean = 28.2 ± 4.9). Patients reported daily stress levels (5-point Likert-type scale, 0 = none, 4 = extreme), physical activity, carbohydrate intake, insulin boluses and basal rates. Daily reported carbohydrates, total insulin bolus, and average blood glucose (BG from CGM) were compared among patients based on their BMI levels on days with different stress levels. In addition, daily averages of a model-based "effectiveness index" (quantifying the combined impact of insulin and carbohydrate on glucose levels) were defined and compared across stress levels to capture meal and insulin independent glycemic changes.
Analyses showed that patient BMI likely moderated stress related glycemic changes. Linear mixed effect model results were significant for the stress-BMI interaction on both behavioral and behavior-independent glycemic changes. Across participants, under stress, an increase was observed in daily carbohydrate intake and effectiveness index at higher BMI. There was no significant interactive effect on daily insulin or average BG.
Findings suggest that (1) stress has both behavioral and nonbehavioral glycemic effects on T1D patients and (2) the direction and magnitude of these effects are potentially influenced by level of stress and patient BMI. Possibly responsible for these observed effects are T1D/BMI related alterations in endocrine response.
本研究旨在探讨1型糖尿病患者的体重指数（BMI）与心理应激导致的不同血糖反应之间的关系。
连续一周收集了37名BMI范围在21.5至39.4kg/m²（平均=28.2±4.9）的患者的连续血糖监测（CGM）数据。患者报告每日应激水平（5点李克特量表，0=无，4=极度）、身体活动、碳水化合物摄入量、胰岛素推注量和基础率。根据不同应激水平日的BMI水平，比较患者每日报告的碳水化合物、总胰岛素推注量和平均血糖（来自CGM的血糖）。此外，定义了基于模型的“有效性指数”（量化胰岛素和碳水化合物对血糖水平的综合影响）的每日平均值，并在不同应激水平之间进行比较，以捕捉与进餐和胰岛素无关的血糖变化。
分析表明，患者的BMI可能会调节应激相关的血糖变化。线性混合效应模型结果显示，应激与BMI的相互作用对行为性和非行为性血糖变化均具有显著性。在所有参与者中，在应激状态下，较高BMI患者的每日碳水化合物摄入量和有效性指数均有所增加。每日胰岛素或平均血糖水平无显著交互作用。
研究结果表明：（1）应激对1型糖尿病患者的血糖有行为性和非行为性影响；（2）这些影响的方向和程度可能受应激水平和患者BMI的影响。观察到的这些效应可能是由于1型糖尿病/BMI相关的内分泌反应改变所致。
