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A new review article explores how precision monitoring of blood glucose can be informed by the connections among self-care behaviors, mental health, and glucose level maintenance.
Growing evidence suggests the existence of connections among self-care behaviors, mental health, and maintenance of glucose levels among those with diabetes, according to a recent review article in the journal Diabetologia on achieving better precision monitoring of blood glucose.
According to the authors, automated integration of these characteristics and possibly others could lead to better precision therapeutics and precision diagnosis.
Precision monitoring of glucose levels has improved in the last 5 years, the authors wrote, thanks to advances in continuous glucose monitoring (CGM). However, the authors noted that little progress has been made in identifying subgroups of people with diabetes based on CGM data and tailoring treatment accordingly.
The integration of CGM with other monitoring technologies such as devices, apps, and trackers that collect information on individuals’ moods, sleep patterns, eating habits, and psychological variables may allow for more intelligent processing and interpretation of glucose data, by putting CGM information in context, according to the authors.
“By combining CGM data with the monitoring of these contextual variables, precision monitoring in diabetes can be achieved. This is in line with the current [American Diabetes Association] and [European Association for the Study of Diabetes] consensus statement that calls for precision monitoring. Based on the consensus statement, precision monitoring is defined as the multimodal assessment of glucose, behaviors, diet, sleep and psychophysiological stress,” said researchers.
The authors of this narrative review offered 5 key areas needed in precision monitoring for diabetic patients.
People with diabetes must manage more than just their glucose levels. They may also need to administer their own insulin injections, take medications, track their eating habits and exercise, schedule foot care and maintain a generally healthy lifestyle.
The need to actively manage so many important aspects of one’s life may consequently present itself as a burden, causing elevated stress, mental health problems, and an overall lower quality of life.
Several studies included in the review found that rising rates of postprandial glucose excursions directly correlated to negative moods, such as depression and anxiety. However, correlation between glycemic variables and positive moods was not found.
These studies support growing evidence that negative mood is correlated with high or low glucose levels, while positive mood and normal glucose levels are coincidental.
Further studies that measure both Ecological Momentary Assessment (EMA) and CGM may help identify different subgroups of diabetic patients. The authors describe EMA as “a methodology that allows the repeated daily sampling of participants’ experiences and behaviours in their everyday lives.”
The authors specify 2 levels of interventions that could occur based on subgroups identified in precision monitoring:
“From the point of view of ‘precision therapeutics,’ different therapy strategies might be offered to the 2 subgroups: for the first subgroup interventions to improve mental health could be more effective when including the diabetes context; and for the latter subgroup improvement of glycemic control and mental health could be addressed independently,” the authors said.
Behavior and Glycemic Control Studies
Sleep and Glycemic Control Studies
Observational data suggest impaired sleep quality to be more prevalent in people with diabetes, and related to the occurrence of T2D, inflammation, insulin resistance, and appetite and weight gain.
The authors called for additional studies to address knowledge gaps in order to achieve precision monitoring.
“While precision monitoring is not yet established, it is a next step towards giving people with diabetes and healthcare professionals the tools to better understand the intricacies of diabetes therapy and help inform appropriate management,” said researchers.
Reference
Hermanns N, Ehrmann D, Shapira A, Kulzer B, Schmitt A, Laffel L. Coordination of glucose monitoring, self-care behaviour and mental health: achieving precision monitoring in diabetes. Diabetologia. 2022;65(11):1883-1894. doi:10.1007/s00125-022-05685-7