Impact of glycemic variability on cognitive impairment, disordered eating behaviors and self-management skills in patients with type 1 diabetes: study protocol for a cross-sectional online study, the Sugar Swing study

Abstract

Background: People living with type 1 diabetes (PWT1D) are at increased risk for impairments in brain function, which may impact on daily life. Cognitive impairments in PWT1D might contribute to increasing eating disorders, reducing self-management skills, and deteriorating glycemic control. Glycemic variability may be a key determinant of disordered eating behaviors, as well as of cognitive impairments. The main objective of this study is to better understand the impact of glycemic variability in disordered eating behaviors and cognitive impairment, and its consequences on self-management skills in PWT1D.

Method: We aim to recruit 150 PWT1D with 50% of men and women in this cross-sectional study. Participants will record their glycemic variability over a 10-day period using a continuous glucose monitoring system (CGMS) and track their dietary intakes using image-assisted food tracking mobile application (2 days). Over four online visits, eating behaviors, diabetes self-management's skills, anxiety disorders, depression disorder, diabetes literacy and numeracy skills, cognitive flexibility, attention deficit, level of interoception, and impulsivity behaviors will be assessed using self-reported questionnaires. Cognitive functions (i.e., attention, executive functions, impulsivity, inhibition and temporal discounting), will be measured. Finally, medical, biological and sociodemographic data will be collected. To further our understanding of the PWT1D experience and factors impacting glycemic self-management, 50 PWT1D will also participate in the qualitative phase of the protocol which consist of individual in-depth face-to-face (virtual) interviews, led by a trained investigator using a semi-structured interview.

Discussion: This study will contribute to highlighting the consequences of blood sugar fluctuations (i.e., "sugar swings"), in daily life, especially how they disrupt eating behaviors and brain functioning. A better understanding of the mechanisms involved could eventually allow for early detection and management of these problems. Our study will also seek to understand the patients' point of view, which will allow the design of appropriate and meaningful recommendations.

Trial registration: ClinicalTrials.gov, NCT05487534. Registered 4 August 2022.

Keywords: Attention; Cognition; Continuous glucose monitoring; Disordered Eating; Eating Behaviors; Glycemic Variability; Impulsivity; Self-management; Type 1 Diabetes.

Conflict of interest statement

S Iceta has received research grants from Takeda; has been a consultant or member on advisory panels for Takeda and Bausch Health; has received research grants from Diabetes Canada; and has received honoraria for a conference sponsored by Takeda, CCRN and Bausch Health. C. Bégin has received honoraria for a conference sponsored by Takeda and Bausch Health. A-S Brazeau has received honoraria for a conference sponsored by Dexcom. R. Rabasa-Lhoret has received research grants from Diabetes Canada; Cystic Fibrosis Canada; CIHR; Janssen; JDRF; Société Francophone du Diabète; FFRD; has been a consultant or member on advisory panels for Boehringer I; INESSS; has received honoraria for conferences sponsored by Boehringer I; Tandem. R.R.L. also benefits from unrestricted grants for clinical and educational activities from Abbott, Eli Lilly, Medtronic, Merck, Novo Nordisk and Sanofi-Aventis, and holds intellectual property in the field of type 2 diabetes risk biomarkers, catheter life and the closed-loop system. C. Gagnon has received a research grant from Novo Nordisk, Takeda, Shire and Ascendis Pharma; has been a member of the advisory panel for Novo Nordisk and has received honoraria for a conference sponsored by Amgen. No other authors have any conflicts of interest to declare.

© 2022. The Author(s).

Figures

Fig. 1

Schematic representation of the methodology for the “Sugar Swing study”. Legend: CGMS: continuous glucose monitoring system; CV: coefficient of variation; BMI: Body Mass Index; PHQ-9: Patient Health Questionnaire; GAD-7: General Anxiety Disorder; DNT: Diabetes Numeracy Test; DBRS: Diabetes Behavior Rating Scale; T1-DDS: Type 1 Diabetes Distress Scale; EDE-Q: Eating Disorder Examination Questionnaire MAIA v2: Multidimensional Assessment of Interoceptive Awareness; mYFAS: modified Yale Food Addiction Scale; ADHD: Attention Deficit Hyperactive Disorder; eGDR: estimated Glucose Disposal Rate; *e.g., CGMS < 10 days, missing data > 15%

Fig. 2

Potential mediation analysis schema with cognitive impairment, interoception and insulin resistance as potential mediators of the relationship between glycemic variability and disordered eating behaviors, using sex/gender and diabetes numeracy as moderators