Time With Diabetes Distress and Glycemia-Specific Distress: New Patient-Reported Outcome Measures for the Psychosocial Burden of Diabetes Using Ecological Momentary Assessment in an Observational Study

Ehrmann, Dominic; Schmitt, Andreas; Priesterroth, Lilli; Kulzer, Bernhard; Haak, Thomas; Hermanns, Norbert

doi:10.2337/dc21-2339

Cited by 21 publications

(17 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Glucose values and HRV were recorded daily for 26 days using continuous glucose monitoring (CGM) and a wrist‐worn health tracker respectively. A detailed description of the study is available elsewhere, 22 and the full study protocol is available from http://clinicaltrials.gov (Reg. No.…”

Section: Methodsmentioning

confidence: 99%

Reduced heart rate variability in people with type 1 diabetes and elevated diabetes distress: Results from the longitudinal observational DIA‐LINK1 study

et al. 2023

Self Cite

View full text Add to dashboard Cite

Aims People with type 1 diabetes have a higher risk for cardiovascular disease (CVD). Reduced heart rate variability (HRV) is a clinical marker for CVD. In this observational study using continuous HRV measurement across 26 days, we investigated whether psychological stressors (diabetes distress, depressive symptoms) and glycaemic parameters (hypo‐ and hyperglycaemic exposure, glycaemic variability and HbA1c) are associated with lower HRV in people with type 1 diabetes. Methods Data from the non‐interventional prospective DIA‐LINK1 study were analysed. At baseline, depressive symptoms and diabetes distress were assessed. Glucose values and HRV were recorded daily for 26 days using continuous glucose monitoring (CGM) and a wrist‐worn health tracker respectively. Multilevel modelling with participant as nesting factor was used to analyse associations between day‐to‐day HRV and diabetes distress, depressive symptoms and CGM‐derived parameters. Results Data from 149 participants were analysed (age: 38.3 ± 13.1 years, HbA1c: 8.6 ± 1.9%). Participants with elevated diabetes distress had a significantly lower HRV across the 26 days compared to participants without elevated distress (β = −0.28; p = 0.004). Elevated depressive symptoms were not significantly associated with HRV (β = −0.18; p = 0.074). Higher daily exposure to hyperglycaemia (β = −0.44; p = 0.044), higher average exposure to hypoglycaemia (β = −0.18; p = 0.042) and higher HbA1c (β = −0.20; p = 0.018) were associated with reduced HRV across the 26 days. Sensitivity analysis with HRV averaged across all days corroborated these results. Conclusions Diabetes distress is a clinically meaningful psychosocial stressor that could play a role in the cardiovascular health of people with type 1 diabetes. These findings highlight the need for integrated psychosocial care in diabetes management.

show abstract

Section: Methodsmentioning

confidence: 99%

Reduced heart rate variability in people with type 1 diabetes and elevated diabetes distress: Results from the longitudinal observational DIA‐LINK1 study

et al. 2023

Self Cite

View full text Add to dashboard Cite

show abstract

“…NCT03811132); participants were enrolled from 3/2019–3/2020 and followed over three months. Measurements comprised repeated surveys (including DSMQ-R, PAID, T1-DDS, CES-D), HbA 1c estimation, 17-day ecological momentary assessment (EMA) with daily diabetes-related questions and 4-week continuous glucose monitoring (CGM) ( 29 ). The study was approved by the Ethics Committee of the German Psychological Society (file no.…”

Section: Methodsmentioning

confidence: 99%

“…Daily diabetes problems/burdens: The DIA-LINK studies included a smartphone-based EMA with daily diabetes-related questions over 17 days ( 29 ). Items constituting likely correlates of the DSMQ-R were used as convergent criteria (e.g., ‘How much have you felt guilty when neglecting your diabetes treatment today?’; full item details in Supplementary Table 4 ).…”

Section: Methodsmentioning

confidence: 99%

A Self-Report Measure of Diabetes Self-Management for Type 1 and Type 2 Diabetes: The Diabetes Self-Management Questionnaire-Revised (DSMQ-R) – Clinimetric Evidence From Five Studies

Schmitt

Kulzer

Ehrmann

et al. 2022

Front. Clin. Diabetes Healthc.

Self Cite

View full text Add to dashboard Cite

AimsMeasurement tools to evaluate self-management behavior are useful for diabetes research and clinical practice. The Diabetes Self-Management Questionnaire (DSMQ) was introduced in 2013 and has become a widely used tool. This article presents a revised and updated version, DSMQ-R, and evaluates its properties in assessing self-management practices in type 1 diabetes (T1D) and type 2 diabetes (T2D).MethodsThe DSMQ-R is a multidimensional questionnaire with 27 items regarding essential self-management practices for T1D and T2D (including diabetes-adjusted eating, glucose testing/monitoring, medication taking, physical activity and cooperation with the diabetes team). For the revised form, the original items were partially amended and the wording was updated; eleven items were newly added. The tool was applied as part of health-related surveys in five clinical studies (two cross-sectional, three prospective) including a total of 1,447 people with T1D and T2D. Using this data base, clinimetric properties were rigorously tested.ResultsThe analyses showed high internal and retest reliability coefficients for the total scale and moderate to high coefficients for the subscales. Reliability coefficients for scales including the new items were consistently higher. Correlations with convergent criteria and related variables supported validity. Responsiveness was supported by significant short to medium term changes in prospective studies. Significant associations with glycemic outcomes were observed for DSMQ-R-assessed medication taking, glucose monitoring and eating behaviors.ConclusionsThe results support good clinimetric properties of the DSMQ-R. The tool can be useful for research and clinical practice and may facilitate the identification of improvable self-management practices in individuals.

show abstract

“…Variations in blood glucose, which occur over the course of minutes to hours, are associated with short-term cognitive variability [8][9][10][11][12] in controlled studies and may indirectly impact psychological and other physiological states [13][14][15]. We are aware of 3 other ongoing studies that are using continuous glucose monitoring (CGM) coupled with EMA in adults with T1D: The Function and Emotion in Everyday Life with T1D study [16], Hypoglycaemia -Redefining Solutions for better lives project [17], and Towards a Better Understanding of Diabetes Distress, Depression and Poor Glycaemic Control study [18]. One of these studies does not include ambulatory cognitive assessment [18], and the other 2 have not yet reported results [16,17].…”

Section: Ema For Individuals With Type 1 Diabetesmentioning

confidence: 99%

“…We are aware of 3 other ongoing studies that are using continuous glucose monitoring (CGM) coupled with EMA in adults with T1D: The Function and Emotion in Everyday Life with T1D study [16], Hypoglycaemia -Redefining Solutions for better lives project [17], and Towards a Better Understanding of Diabetes Distress, Depression and Poor Glycaemic Control study [18]. One of these studies does not include ambulatory cognitive assessment [18], and the other 2 have not yet reported results [16,17].…”

Section: Ema For Individuals With Type 1 Diabetesmentioning

confidence: 99%

Glycemic Variability and Fluctuations in Cognitive Status in Adults With Type 1 Diabetes (GluCog): Observational Study Using Ecological Momentary Assessment of Cognition

Fonseca¹,

Strong²,

Singh³

et al. 2023

JMIR Diabetes

View full text Add to dashboard Cite

Background Individuals with type 1 diabetes represent a population with important vulnerabilities to dynamic physiological, behavioral, and psychological interactions, as well as cognitive processes. Ecological momentary assessment (EMA), a methodological approach used to study intraindividual variation over time, has only recently been used to deliver cognitive assessments in daily life, and many methodological questions remain. The Glycemic Variability and Fluctuations in Cognitive Status in Adults with Type 1 Diabetes (GluCog) study uses EMA to deliver cognitive and self-report measures while simultaneously collecting passive interstitial glucose in adults with type 1 diabetes. Objective We aimed to report the results of an EMA optimization pilot and how these data were used to refine the study design of the GluCog study. An optimization pilot was designed to determine whether low-frequency EMA (3 EMAs per day) over more days or high-frequency EMA (6 EMAs per day) for fewer days would result in a better EMA completion rate and capture more hypoglycemia episodes. The secondary aim was to reduce the number of cognitive EMA tasks from 6 to 3. Methods Baseline cognitive tasks and psychological questionnaires were completed by all the participants (N=20), followed by EMA delivery of brief cognitive and self-report measures for 15 days while wearing a blinded continuous glucose monitor. These data were coded for the presence of hypoglycemia (<70 mg/dL) within 60 minutes of each EMA. The participants were randomized into group A (n=10 for group A and B; starting with 3 EMAs per day for 10 days and then switching to 6 EMAs per day for an additional 5 days) or group B (N=10; starting with 6 EMAs per day for 5 days and then switching to 3 EMAs per day for an additional 10 days). Results A paired samples 2-tailed t test found no significant difference in the completion rate between the 2 schedules (t17=1.16; P=.26; Cohen dz=0.27), with both schedules producing >80% EMA completion. However, more hypoglycemia episodes were captured during the schedule with the 3 EMAs per day than during the schedule with 6 EMAs per day. Conclusions The results from this EMA optimization pilot guided key design decisions regarding the EMA frequency and study duration for the main GluCog study. The present report responds to the urgent need for systematic and detailed information on EMA study designs, particularly those using cognitive assessments coupled with physiological measures. Given the complexity of EMA studies, choosing the right instruments and assessment schedules is an important aspect of study design and subsequent data interpretation.

show abstract

Time With Diabetes Distress and Glycemia-Specific Distress: New Patient-Reported Outcome Measures for the Psychosocial Burden of Diabetes Using Ecological Momentary Assessment in an Observational Study

Cited by 21 publications

References 27 publications

Reduced heart rate variability in people with type 1 diabetes and elevated diabetes distress: Results from the longitudinal observational DIA‐LINK1 study

Reduced heart rate variability in people with type 1 diabetes and elevated diabetes distress: Results from the longitudinal observational DIA‐LINK1 study

A Self-Report Measure of Diabetes Self-Management for Type 1 and Type 2 Diabetes: The Diabetes Self-Management Questionnaire-Revised (DSMQ-R) – Clinimetric Evidence From Five Studies

Glycemic Variability and Fluctuations in Cognitive Status in Adults With Type 1 Diabetes (GluCog): Observational Study Using Ecological Momentary Assessment of Cognition

Contact Info

Product

Resources

About