Stricter glucose control may affect quality of life in people living with diabetes

New research to be presented at the Annual Meeting of The European Association for the Study of Diabetes (EASD) in Milan, Italy (Sept 28 – Oct 2) shows that, in people living with diabetes (type 1 or 2) using data from continuous glucose monitoring (CGM) devices paired with daily quality-of-life ratings, days with more widely fluctuating glucose readings (while still within safe limits) are followed by days with a better quality life compared to days with more stricter control– suggesting the burden of that stricter control could be preventing those individuals with stricter control from enjoying various activities. The study is by Professor Dominic Ehrmann, FIDAM (Research Institute Diabetes Academy Mergentheim), Bad Mergentheim, Germany, and colleagues.

Maintaining and improving quality of life in people with diabetes is a central therapeutic goal. Understanding day-to-day factors in the daily lives of people with diabetes is therefore essential to better capture potential influences on quality of life. The aim of this analysis was to investigate the impact of CGM-derived glucose parameters on daily quality of life in individuals with type 1 and type 2 diabetes.

The PRO-MENTAL study, funded by the German Centre for Diabetes Research (DZD), quality of life was assessed daily over 14 consecutive days using ecological momentary assessment (EMA) based on the WHO-5 questionnaire. The questionnaire asks five questions:

1. I have felt cheerful and in good spirits

2. I have felt calm and relaxed

3. I have felt active and vigorous

4. I woke up feeling fresh and rested

5. My daily life has been filled with things that interest me

In addition, daily sleep quality as well as perceived stress, mood, and energy levels were recorded using the same EMA method. CGM data were analysed over the 14-day EMA period, and the following parameters were analysed: blood sugar time below safe range (TBR: <70 mg/dl), time above safe range (TAR: >180 mg/dl), time in normal range (normoglycemia) (TING: 70-140 mg/dl), and glucose variability.

Statistical modelling was applied to examine whether glucose parameters as well as sleep quality, stress, mood, and energy on the previous day predicted next-day quality of life. Additionally, a separate analysis was conducted in which all variables from the same day were included as predictors of quality of life. All models were adjusted for age, sex, and diabetes type, and prior-day quality of life was included to check this was not heavily affecting the results.

Data from 400 individuals with diabetes were analysed (72% type 1 diabetes, 28% type 2 diabetes, 55% female, age 47 years (range 32-63 years), mean glycated haemoglobin (HbA1c – a measure of blood sugar control) 7.6%.

Higher glucose variability and greater time in normoglycaemia on the previous day were significantly associated with higher quality of life on the following day. Time above and below the safe range on the previous day showed no statistically significant association. Higher sleep quality during the preceding night and higher energy levels on the previous day (by asking how energetic the person felt on a scale for 0 [not at all] to 10 [very much] were also associated with improved next-day quality of life. Same day glucose parameters were not associated with quality of life on that day.

The authors say: "Days with higher time in the normal safe range for blood sugar were followed by days on which individuals with type 1 and type 2 diabetes reported better quality of life, underscoring the importance of optimal blood sugar control for well-being.

"Interestingly, higher-than-usual glucose variability was also associated with improved next-day quality of life. These findings may suggest that individuals experience lower quality of life when attempting to minimise glucose fluctuations too strictly, potentially due to the associated burden or restrictions in daily life, which may contribute to some people living with diabetes feeling unable to safely engage in certain activities".