Spotlight on perceptions of glycemic control

Two recent studies, both published by Diabetologia on July 30, looked at the effects of patients' perceptions of glycemic control.

The first study used an app to examine the impact of hypoglycemia on daily functioning of patients with insulin-treated diabetes. For 70 consecutive days, 274 adults with type 1 diabetes and 320 with type 2 diabetes reported in the app three times a day about any hypoglycemia and their current function. They also wore blinded glucose sensors. Hypoglycemia that was only detected by the sensor, not reported by the patient, was not associated with any change in daily functioning scores. Patient-reported hypoglycemia, whether day or night, was significantly associated with worse energy levels, mood, and cognitive functioning, as well as fear of hypoglycemia later that day or while asleep. The results have implications for clinical care, particularly the use of continuous glucose monitors (CGMs), the study authors noted. “These findings emphasise the need for researchers and clinicians to consider the burden on people with insulin-treated diabetes not only in experiencing low glucose levels but also in recognising, managing and avoiding episodes of hypoglycaemia, and indicate a need for critical review of the importance to the wearer of hypoglycaemia episodes that are only detected by the sensor,” they wrote.

The other study, a prospective observational study, assessed the relationship between diabetes distress and hypoglycemia, hyperglycemia, and glucose variability. Patients also used an app, reporting daily for 17 days about their perceptions of glucose control, while also wearing a CGM. A total of 379 participants were included in the final analysis (50.9% with type 1 diabetes). Perceived glucose variability and perceived hyperglycemia were the strongest predictors of daily diabetes distress. CGM-based glucose variability was not significantly associated with distress. However, there was great heterogeneity from participant to participant in the associations between perceived and measured glycemic control and diabetes distress, the study authors noted. Those who were more distressed by perceived glycemic excursions had more depressive symptoms, diabetes distress, and hypoglycemia fear. Those whose distress was tied to CGM-measured glucose control had higher levels of psychosocial well-being but also higher HbA1c levels. The study highlights the importance of clinicians taking an individualized approach to diabetes distress that differentiates whether it is tied to perceptions of glycemic control or CGM reporting, the authors said. “For the former, the results suggest that it may be reasonable to shift the attention to the objective glucose values and discuss personal goals and attitudes regarding CGM-based glucose parameters. For the latter, therapy adjustments may affect the experience of diabetes distress,” they recommended.