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 health-related 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.

Figures

FIG. 1.

Observed and predicted (24-cycle Fourier approximateion) sensor glucose values for study participants. r2=0.984. BG, blood glucose.

FIG. 2.

Partial correlation of the health and functioning quality of life with continuous overall net glycemic action (CONGA) 1–6 adjusted by age and weight. Note that all six CONGA correlations with health and functioning quality of life are statistically significant at P<0.05 by virtue of all exceeding the 95th percentile of the maximum of six correlations based on 10,000 simulations where the true correlations were 0. CB, confidence bound (same as confidence interval). Color images available online at www.liebertonline.com/dia

FIG. 3.

Energy at eight cycles per 24 h versus trait anxiety score. Color images available online at www.liebertonline.com/dia

FIG. 4.

Partial correlation of trait anxiety score with continuous glucose monitoring energy components adjusted by age and weight. *Randomly permuting the 23 subjects and computing the maximum correlations among the first 12 cycles (10,000 repetitions), only 4.3% of these simulated maxima exceeded the observed correlation at a frequency of eight cycles per 24 h. CB, confidence bound (same as confidence interval). Color images available online at www.liebertonline.com/dia