Young adults with type 1 diabetes tend to have higher A1C levels (a measure of long-term blood glucose control) if they have greater diabetes-related distress, according to a new study published in the journal Diabetic Medicine.
Previous studies have found that diabetes distress — worrying or feeling bad about your diabetes or blood glucose control — is linked to worse diabetes-related outcomes, including worse blood glucose control. But it’s difficult in some studies to figure out if worse blood glucose control might be a source of distress, rather than an outcome caused by distress. It also sometimes isn’t clear if being distressed leads people to take fewer measures to adequately control their blood glucose levels.
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For the latest study, researchers were particularly interested in whether the relationship between diabetes distress and blood glucose control was the same in young adults with type 1 diabetes who either used or did not use an insulin pump or continuous glucose monitoring (CGM) system. Presumably, using these devices could leave fewer opportunities for worse blood glucose control, regardless of a person’s level of diabetes distress.
The researchers looked at data from 419 adults with type 1 diabetes, ages 19 to 31, who received care at a diabetes specialty clinic in New York City and completed an online questionnaire. Their answers were used to create a diabetes distress score, with a score of 3 or higher (out of 6) indicating a “high” score for the purposes of the study. The researchers then compared distress scores with participants’ A1C levels, as measured in their visits to the clinic. In doing this, they adjusted for social and demographic factors to the best of their ability, since having a lower income or belonging to a minority racial group, for example, might affect a person’s level of diabetes distress.
Among all study participants, 59% were female, and 69% identified as non-Hispanic white. When it came to device use, 35% used both an insulin pump and a CGM system, 42% used one device or the other, and 24% didn’t use any wearable diabetes devices. The average A1C level among all participants was 8.0%, and 24% of participants had a high level of diabetes distress as indicated by their survey responses.
High levels of diabetes distress linked to higher A1C
Participants with a high level of diabetes distress had an A1C level that was greater, on average, by 0.9% compared with those without a high level of diabetes distress — a significant difference that indicates notably higher blood glucose levels. Whether or not participants used an insulin pump or CGM system made basically no difference when it came to the relationship between diabetes distress and A1C. Among participants who used both devices, those with high diabetes distress had a 0.8% higher A1C level, on average, than participants without high diabetes distress. Among participants who used neither device, A1C was also 0.8% higher, on average, in those with high diabetes distress.
High diabetes distress in young adults “requires more attention because it is associated with higher [A1C] levels, even among those using insulin pumps and CGMs,” the researchers concluded. This finding suggests that health care providers should consider screening people with diabetes — at least younger adults with type 1 — for higher levels of diabetes distress, and possibly try to craft solutions to reduce diabetes distress in these patients.
Want to learn more about A1C? Read “How to Lower A1C Levels Naturally,” “How to Lower Your A1C Levels: More Steps You Can Take” and “HbA1c: What It Is and Why It Matters.”