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Gepubliceerd in:

03-06-2020

A daily study of stressors, continuously measured glucose, and diabetes symptoms in latinos with type 2 diabetes

Auteurs: Julie Wagner, Stephen Armeli, Howard Tennen, Angela Bermudez-Millan, Howard Wolpert, Rafael Pérez-Escamilla

Gepubliceerd in: Journal of Behavioral Medicine | Uitgave 1/2021

Abstract

This study examined whether daily stressors and continuously monitored glucose levels and glucose variability predict daily diabetes symptoms. Fifty Latinos with type 2 diabetes were randomized to either diabetes education (DE-only; N = 23) or DE plus stress management and relaxation training (DE + SMR; N = 32). After treatment, for 7 days they wore ‘blinded’ continuous glucose monitors and reported common stressors and diabetes symptoms twice daily. Between individuals, participants with more numerous overall stressors and more time in hyperglycemia reported higher symptoms. Within individuals, symptoms were higher during intervals of greater than usual stressors. Yet, diabetes symptoms did not covary with changes in glucose levels or glucose variability. The within-person stressor-symptom association was stronger among older individuals and non-significant for participants in DE + SMR condition. Diabetes symptoms were associated with recent stressor exposure, but not recent glucose level or changes in glucose.

Clinical Trial Number

ClinicalTrials.gov Identifier (No. NCT01578096).

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We initially examined 3-level HLM specifications (i.e., morning and evening intervals (reports) nested within days nested within-persons). However, results indicated no day level variation, and in many cases, models would not converge. Therefore, we used a more parsimonious 2-level specification of intervals nested in persons.

We initially estimated models specifying random effects for the intercepts and the level 1 stress and glucose slopes. Glucose slopes variance components were not significant in either model, therefore were fixed to zero.

Similar findings were found with simple slopes tested in model 2 (controlling for glucose SD).

In an exploratory fashion, we calculated the largest increase in glucose during 10-h window. Specifically, for each window we identified the largest change from the nadir to peak and re-estimated the HLMs with this index. Results showed that maximum increase was not associated with symptoms overall and that the association between interval level maximum increase did not vary as a function of the person level moderators.

All interactions were modeled simultaneously in order to control for each other. To examine whether any of the non-significant moderators of the CGM predictors were significant when examined in isolation, we re-estimated the models testing each interaction separately. Results did not change; none of them was significant.

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Titel: A daily study of stressors, continuously measured glucose, and diabetes symptoms in latinos with type 2 diabetes
Auteurs: Julie Wagner
Stephen Armeli
Howard Tennen
Angela Bermudez-Millan
Howard Wolpert
Rafael Pérez-Escamilla
Publicatiedatum: 03-06-2020
Uitgeverij: Springer US
Gepubliceerd in: Journal of Behavioral Medicine / Uitgave 1/2021
Print ISSN: 0160-7715
Elektronisch ISSN: 1573-3521
DOI: https://doi.org/10.1007/s10865-020-00162-1

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