Novel predictors of daily fluctuations in glycemia and self-management in adolescents and young adults with type 1 diabetes.

Abstract

AIMS:

To understand morning biopsychosocial factors that predict glycemia, adherence, and goal attainment in adolescents and young adults (AYA) with type 1 diabetes (T1D) on a daily basis.

METHODS:

Eight-eight AYA (mean 17.6 ± 2.6 years, 54% female, HbA1c 7.9 ± 1.4%, diabetes duration 8.5 ± 4.5 years) with T1D who use Continuous Glucose Monitoring (CGM) completed a 2-week prospective study. Participants chose a self-management goal to focus on during participation. For six days, participants prospectively completed a 25-item Engagement Prediction Survey to assess biopsychosocial factors to predict daily diabetes outcomes and an end-of-day Goal Survey. Lasso and mixed-model regression were used to determine items in the Engagement Prediction Survey most predictive of perceived goal attainment, CGM Time-in-Range (TIR, 70-180 mg/dl), sensor mean glucose, number of insulin boluses and hyperglycemia response (bolus within 30 min of high alert or glucose <200 mg/dl within 2 hours).

RESULTS:

A 7-item model (including current glucose, planning/wanting to manage diabetes, wanting to skip self-management, feeling good about self, health perception and support needs) explained 16.7% of the daily variance in TIR, 18.6% of mean sensor glucose, 2.1% of the number of boluses, 14% of hyperglycemia response, and 28.7% of goal attainment perceptions. The mean absolute change in day-to-day TIR was 16%, sensor glucose was 30 mg/dl, and the number of boluses was 2. AYA reported more positive Engagement Prediction Survey responses on mornings when they awoke with lower glucose levels.

CONCLUSIONS:

Morning biopsychosocial state factors predict glycemic and adherence outcomes in AYA with diabetes and could be a novel intervention target for future behavioural interventions.

• Authors: Laurel H Messer, Tim Vigers, Laura Pyle, Emily Fivekiller, R Paul Wadwa, Teri L Hernandez, Paul F Cook
• Journal: Diabetic medicine : a journal of the British Diabetic Association (Diabet Med) Vol. 39 Issue 9 Pg. e14910 (09 2022) ISSN: 1464-5491 [Electronic] England
• PMID: 35776655 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2022 Diabetes UK.

Chemical References

• Blood Glucose
• Glycated Hemoglobin A
• Hypoglycemic Agents
• Insulin

Topics

• Adolescent
• Blood Glucose
• Blood Glucose Self-Monitoring
• Diabetes Mellitus, Type 1 (drug therapy, psychology)
• Female
• Glycated Hemoglobin (analysis)
• Humans
• Hyperglycemia (prevention & control)
• Hypoglycemic Agents (therapeutic use)
• Insulin (therapeutic use)
• Male
• Prospective Studies
• Self-Management
• Young Adult