Diabetes-Related Distress and Glycemic Dysregulation in Everyday Life With Type 1 Diabetes: Which Comes First?

作者：Jeffrey S. Gonzalez, Claire J. Hoogendoorn, Raymond Hernandez, Stefan Schneider, Fayel Mustafiz, Megha Siddhanta, Elizabeth A. Pyatak · 发表于：Diabetes Care · 年份：2025 · DOI：10.2337/dc25-0559 · 被引用次数：8 · 研究领域：Diabetes Management and Research、Diabetes Management and Education、Mental Health Research Topics

OBJECTIVE: 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). RESEARCH DESIGN AND METHODS: 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. RESULTS: 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...