Diabetes distress associated with higher HbA1c for young adults, regardless of device use
High diabetes distress is associated with higher HbA1c levels for young adults with type 1 diabetes, including in those using insulin pumps and continuous glucose monitors, according to findings published in Diabetic Medicine.
“To our knowledge, this is the first study among young adults of the association between diabetes distress and HbA1c levels in those with and without the use of insulin pumps and/or CGMs,” Kathryn E. Nagel, MD, a resident physician at Yale New Haven Hospital, and colleagues wrote. “Diabetes distress has consistently been associated with high HbA1c levels in type 1 diabetes, and our data further support this finding. Unexpectedly, young adults who used insulin pumps and/or CGMs did not report a significantly different prevalence of high diabetes distress than those who used neither device.”
Researchers analyzed data from a 2017 online survey of young adults aged 18 to 29 years with type 1 diabetes receiving care at the Naomi Berrie Diabetes Center at the Columbia University Irving Medical Center in New York. Participants were recruited via email, postal mail and the diabetes center website. The most recent HbA1c was extracted from medical records. The Diabetes Distress Scale was used to measure diabetes stress, with a higher score indicating worse distress. Adults scoring 3 points or higher were considered to have high diabetes distress. The scale included four subdomains: regimen-related distress, emotional burden, interpersonal distress and physician-related distress. Participants reported devices used to manage diabetes and type of insulin administration.
The analysis included 419 survey respondents (59% women; 69% non-Hispanic white; mean age, 24.5 years). Of the study cohort, 63% used an insulin pump, 48% used CGM, 35% used both devices and 24% used no devices.
Of the participants, 24% reported having high diabetes distress, with 34% recording a high score in the regimen-related distress, 40% for emotional burden, 20% for interpersonal distress and 6% for physician-related distress.
After adjusting for all covariates, including device use, adults with high diabetes distress had a 1.1% higher HbA1c compared with those without distress. There was no significant difference in diabetes distress between insulin pump and CGM users and nonusers. High diabetes distress was associated with higher HbA1c, regardless of device use. Participants with high diabetes distress who reported using an insulin pump and CGM had a 0.8% higher HbA1c than those without high distress using both devices. Similarly, among those who reported not using any device, adults with high diabetes distress had a 0.8% higher HbA1c compared with non-device users without high distress.
“Our study fills an important gap in our understanding of diabetes distress in young adults,” the researchers wrote. “Particularly notable are the high prevalence of diabetes distress and regimen-related distress despite use of diabetes devices. While users of insulin pumps and CGMs have overall lower HbA1c levels than those who do not use the devices, the benefit of device use diminishes when high diabetes distress is present. Diabetes distress may be an important barrier in preventing young adults from realizing the benefits of modern diabetes devices.”