New research suggests that maintaining extremely stable blood sugar levels may result in an unexpected tradeoff for some people with diabetes.
The findings, which will be presented at the annual meeting of the European Association for the Study of Diabetes (EASD) in Milan, Italy (September 28 – October 2), indicate that people with type 1 or type 2 diabetes sometimes reported better quality of life after days when their glucose levels fluctuated more, as long as those levels remained within safe limits.
Researchers linked data from continuous glucose monitoring (CGM) devices to daily assessments of well-being. Their findings suggest that the effort and restrictions needed to minimize each blood sugar fluctuation could make it more difficult for some people to enjoy daily activities.
The research was carried out by Professor Dominic Ehrmann from FIDAM (Diabetes Academy Mergentheim Research Institute), Bad Mergentheim, Germany, and colleagues.
Beyond blood sugar numbers
Helping people with diabetes maintain a good quality of life is an important part of treatment. Blood sugar control is important, but researchers also want to understand how daily diabetes management affects mood, energy, sleep, stress and the ability to participate in normal activities.
The new analysis examined whether blood glucose profiles recorded by CGM devices were associated with daily quality of life in people with type 1 and type 2 diabetes.
The data comes from the PRO-MENTAL study, funded by the German Diabetes Research Center (DZD). Participants rated their quality of life every day for 14 consecutive days using a technique known as Ecological Momentary Assessment (EMA) based on the WHO-5 questionnaire.
The questionnaire asks participants to evaluate five statements:
- I felt joyful and in a good mood
- I felt calm and relaxed
- I felt active and vigorous
- I woke up fresh and rested
- My daily life is filled with things that interest me
The researchers also collected daily information on sleep quality, perceived stress, mood and energy using the same EMA approach.
24-hour glucose monitoring
CGM data from the same 14-day period allowed the team to examine several measures of blood sugar control. These included a blood glucose time below the 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.
Glucose variability reflects the extent to which a person’s blood sugar rises and falls over time.
The researchers then used statistical modeling to determine whether one day’s blood sugar patterns, sleep, stress, mood, and energy could predict the next day’s quality of life.
They also performed a separate analysis to see if same-day measurements were associated with that day’s quality of life. Models took into account age, sex and type of diabetes. They also included quality of life from the previous day to ensure it did not strongly influence the results.
400 people with diabetes took part
The analysis included data from 400 people with diabetes (72% type 1 diabetes, 28% type 2 diabetes, 55% women, aged 47 years (range 32-63 years), mean glycated hemoglobin (HbA1c – a measure of blood sugar control) 7.6%.
Two blood glucose profiles stood out.
Spending more time in the normal blood sugar range one day was significantly associated with better quality of life the next day. But more surprisingly, greater blood sugar variability the day before was also linked to better quality of life the next day.
In contrast, the amount of time participants spent above or below the safe blood sugar range the day before was not significantly associated with their quality of life the next day.
Better sleep the night before was also linked to better well-being the next day. The same was true for higher energy levels from the day before (asking how energetic the person felt on a scale of 0 (not at all) to 10 (a lot).
Interestingly, same-day blood glucose measurements were not associated with quality of life that day.
A possible cost of trying to keep blood sugar levels too stable
The results do not suggest that poor blood sugar control is beneficial. In fact, spending more time within normal limits was associated with better quality of life.
Instead, the researchers say the results regarding glucose variability might indicate a different problem. People who work especially hard to eliminate normal fluctuations may sometimes impose restrictions on themselves that make daily life less enjoyable or make certain activities more difficult to continue safely.
The authors state: “Days when time spent in the safe normal range for blood sugar was higher were followed by days when people with type 1 and type 2 diabetes reported better quality of life, highlighting the importance of optimal blood sugar control for well-being.
“Interestingly, higher than usual glucose variability was also associated with better quality of life the next day. These findings may suggest that individuals have a lower quality of life when they attempt to minimize 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.”
Gn Health
