Is Psychological Stress a Factor for Incorporation Into Future Closed-Loop Systems?

Linda A Gonder-Frederick; Jesse H Grabman; Boris Kovatchev; Sue A Brown; Stephen Patek; Ananda Basu; Jordan E Pinsker; Yogish C Kudva; Christian A Wakeman; Eyal Dassau; Claudio Cobelli; Howard C Zisser; Francis J Doyle 3rd

doi:10.1177/1932296816635199

Is Psychological Stress a Factor for Incorporation Into Future Closed-Loop Systems?

J Diabetes Sci Technol. 2016 May 3;10(3):640-6. doi: 10.1177/1932296816635199. Print 2016 May.

Authors

Affiliations

¹ Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA Behavioral Medicine Center, University of Virginia, Charlottesville, VA, USA lag3g@virginia.edu.
² Behavioral Medicine Center, University of Virginia, Charlottesville, VA, USA.
³ Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA Behavioral Medicine Center, University of Virginia, Charlottesville, VA, USA.
⁴ Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA.
⁵ Endocrine Research Unit, Mayo Clinic, Rochester, MN, USA.
⁶ William Sansum Diabetes Center, Santa Barbara, CA, USA.
⁷ William Sansum Diabetes Center, Santa Barbara, CA, USA Department of Chemical Engineering, University of California, Santa Barbara, Santa Barbara, CA, USA John A. Paulson School of Engineering and Applied Science, Harvard University, Cambridge, MA, USA.
⁸ Department of Information Engineering, University of Padova, Padova, Italy.
⁹ Department of Chemical Engineering, University of California, Santa Barbara, Santa Barbara, CA, USA Insulet Corporation, Santa Barbara, CA, USA.

Abstract

Background: The relationship between daily psychological stress and BG fluctuations in type 1 diabetes (T1DM) is unclear. More research is needed to determine if stress-related BG changes should be considered in glucose control algorithms. This study in the usual free-living environment examined relationships among routine daily stressors and BG profile measures generated from CGM readings.

Methods: A total of 33 participants with T1DM on insulin pumps wore a CGM device for 1 week and recorded daily ratings of psychological stress, carbohydrates, and insulin boluses.

Results: Within-subjects ANCOVAs found a significant relationship between daily stress and indices of BG variability/instability (r = .172 to .185, P = .011 to .018, r(2) = 2.97% to 3.43%), increased % time in hypoglycemia (r = .153, P = .036, r(2) = 2.33%) and decreased carbohydrate consumption (r = -.157, P = .031, r(2) = 2.47%). Models accounted for more variance for individuals reporting the highest daily stress. There was no relationship between stress and mean daily glucose or low/high glucose risk indices.

Conclusions: These preliminary findings suggest that naturally occurring daily stressors can be associated with increased glucose instability and hypoglycemia, as well as decreased food consumption. In addition, findings support the hypothesis that some individuals are more metabolically reactive to stress. More rigorous studies using CGM technology are needed to understand whether the impact of daily stress on BG is clinically meaningful and if it is a behavioral factor that should be considered in glucose control systems for some individuals.

Keywords: blood glucose variability; continuous glucose monitoring; psychological stress; type 1 diabetes.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Algorithms*
Blood Glucose
Diabetes Mellitus, Type 1 / blood*
Female
Humans
Insulin Infusion Systems*
Male
Middle Aged
Stress, Psychological / blood*

Substances

Blood Glucose

Abstract

Publication types

MeSH terms

Substances

Grants and funding