Does Glycemic Variability Impact Mood and Quality of Life?

Abstract

Background: Diabetes is a chronic condition that significantly impacts quality of life. Poor glycemic control is associated with more diabetes complications, depression, and worse quality of life. The impact of glycemic variability on mood and quality of life has not been studied. Methods: A descriptive exploratory design was used. Twenty-three women with type 2 diabetes wore a continuous glucose monitoring system for 72 h and completed a series of questionnaires. Measurements included (1) glycemic control shown by glycated hemoglobin and 24-h mean glucose, (2) glycemic variability shown by 24-h SD of the glucose readings, continuous overall net glycemic action (CONGA), and Fourier statistical models to generate smoothed curves to assess rate of change defined as ''energy,'' and (3) mood (depression, anxiety, anger) and quality of life by questionnaires. Results: Women with diabetes and co-morbid depression had higher anxiety, more anger, and lower quality of life than those without depression. Certain glycemic variability measures were associated with mood and quality of life. The 24-h SD of the glucose readings and the CONGA measures were significantly associated with healthrelated quality of life after adjusting for age and weight. Fourier models indicated that certain energy components were significantly associated with depression, trait anxiety, and overall quality of life. Finally, subjects with higher trait anxiety tended to have steeper glucose excursions. Conclusions: Data suggest that greater glycemic variability may be associated with lower quality of life and negative moods. Implications include replication of the study in a larger sample for the assessment of blood glucose fluctuations as they impact mood and quality of life.

The Challenges of Measuring Glycemic Variability

“…If need be, one can use a "resampling" type of statistical calculation to ensure that the multiplicity of hypotheses being tested are not generating spurious indications of statistical significance due to chance events. 29,30 9. The possibility of differing needs for routine clinical practice and for clinical research.…”

Comparison of Eating Pathology in Patients Diagnosed with Diabetes and Hypertension

“…Anxiety has been reported to be as high as 30-40% in persons with diabetes. 26 Several studies have found the presence of an anxiety disorder to be associated with poor glycemic control for patients with diabetes and researchers have suggested that anxiety disorders may be a risk factor for more di- abetes complications, depression and worse quality of life. 27,28 We found no statistical difference between two groups in terms of GHQ-12 scores.…”

“…Likewise, exogenous insulin administration results in hunger along with an increased appetite, which is reflected in eating behavior changes. 26 Sodium restriction is the mainstay in treatment of hypertension. A low-salt diet may be expected to cause fluid and electrolyte alterations.…”

Lower Glucose Variability and Hypoglycemia Measured by Continuous Glucose Monitoring With Novel Long-Acting Insulin LY2605541 Versus Insulin Glargine

“…The relationship of glycemic variability to longterm outcomes remains controversial, but studies have demonstrated that clinical relevance in glycemic variability is greater in patients with diabetes who experience hypoglycemia, in particular severe hypoglycemia (6)(7)(8)(9)(10). Consequently, diabetes therapies that can lower glycemic variability may also have the potential to reduce the risk of hypoglycemia and improve quality of life (11).…”