Gonzalez Jeffrey S, Hoogendoorn Claire J, Hernandez Raymond, Schneider Stefan, Mustafiz Fayel, Siddhanta Megha, Pyatak Elizabeth A
Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY.
Department of Medicine (Endocrinology), Albert Einstein College of Medicine, Bronx, NY.
Diabetes Care. 2025 Aug 1;48(8):1453-1460. doi: 10.2337/dc25-0559.
In an observational study, we paired ecological momentary assessment (EMA) and continuous glucose monitoring (CGM) to examine lagged effects of glycemic regulation on diabetes-related distress (DD), and vice versa, among adults with type 1 diabetes (T1D).
Participants (N = 182; median ± SD age 40 ± 14 years; 54% women; 41% Latino; 29% White and 15% Black) wore a blinded CGM device for 14 days and completed five to six EMA surveys per day. We tested expected associations between momentary DD ratings and relevant patient-reported outcomes on validated questionnaires. Using multilevel cross-lagged modeling, we evaluated within-person lagged effects of CGM metrics (mean glucose mean; percentage of time in range [TIR; i.e., 70-180 mg/dL] and percentages of time 181-250, >250, and <70 mg/dL; and coefficient of variation [CV]) over 3-h periods on DD rated 0-100 at the end of that interval and 3 h later. We also examined lagged effects of DD on subsequent CGM metrics.
Momentary DD ratings were significantly associated with results of questionnaires for DD, well-being, functional and mental health, and quality of life. Higher mean glucose, less TIR, greater percentage of time 181-250 and >250 mg/dL, and higher CV over 3 h each predicted greater DD at the end of that interval; higher 3-h mean glucose also predicted more DD 3 h later (P < 0.05). Greater DD unexpectedly predicted a lower percentage of time in hypoglycemia over the next 3 h (P < 0.05) but predicted no other CGM metrics.
Findings support the validity of EMA of DD in adults with T1D and suggest glucose dysregulation is linked to subsequent increased DD over the short term, not vice versa. These findings have implications for interventions targeting DD.
在一项观察性研究中，我们将生态瞬时评估（EMA）与持续葡萄糖监测（CGM）相结合，以研究血糖调节对1型糖尿病（T1D）成年患者糖尿病相关困扰（DD）的滞后影响，反之亦然。
参与者（N = 182；年龄中位数±标准差40±14岁；54%为女性；41%为拉丁裔；29%为白人，15%为黑人）佩戴盲法CGM设备14天，每天完成五到六次EMA调查。我们在经过验证的问卷上测试了瞬时DD评分与相关患者报告结果之间的预期关联。使用多层次交叉滞后模型，我们评估了3小时时间段内CGM指标（平均血糖均值；血糖在目标范围内的时间百分比[TIR；即70 - 180 mg/dL]以及血糖在181 - 250、>250和<70 mg/dL的时间百分比；变异系数[CV]）对该时间段结束时及3小时后0 - 100评分的DD的个体内滞后影响。我们还研究了DD对后续CGM指标的滞后影响。
瞬时DD评分与DD、幸福感、功能和心理健康以及生活质量的问卷结果显著相关。更高的平均血糖、更低的TIR、血糖在181 - 250和>250 mg/dL的时间百分比更高以及3小时内更高的CV，均预测在该时间段结束时DD更高；3小时平均血糖更高还预测3小时后DD更高（P < 0.05）。更大的DD意外地预测在接下来3小时内低血糖时间百分比更低（P < 0.05），但对其他CGM指标无预测作用。
研究结果支持EMA对T1D成年患者DD评估的有效性，并表明血糖失调与短期内随后DD增加有关，反之则不然。这些发现对针对DD的干预措施具有启示意义。
