New research suggests that keeping blood sugar extremely steady may come with an unexpected tradeoff for some people with diabetes.
The findings, which will be presented at the Annual Meeting of The European Association for the Study of Diabetes (EASD) in Milan, Italy (Sept. 28 – Oct. 2), indicate that people with type 1 or type 2 diabetes sometimes reported a better quality of life after days when their glucose levels fluctuated more, provided those levels remained within safe limits.
Researchers paired data from continuous glucose monitoring (CGM) devices with daily well-being assessments. Their results suggest that the effort and restrictions required to minimize every glucose fluctuation could make it harder for some people to enjoy everyday activities.
The research was conducted by Professor Dominic Ehrmann of FIDAM (Research Institute Diabetes Academy Mergentheim), Bad Mergentheim, Germany, and colleagues.
Looking Beyond Blood Sugar Numbers
Helping people with diabetes maintain a good quality of life is an important part of treatment. Blood sugar control matters, but researchers also want to understand how day to day diabetes management affects mood, energy, sleep, stress, and the ability to participate in normal activities.
The new analysis examined whether glucose patterns recorded by CGM devices were associated with daily quality of life among people with type 1 and type 2 diabetes.
The data came from the PRO-MENTAL study, funded by the German Center for Diabetes Research (DZD). Participants rated their quality of life every day for 14 consecutive days using a technique known as ecological momentary assessment (EMA) based on the WHO-5 questionnaire.
The questionnaire asks participants to rate five statements:
- I have felt cheerful and in good spirits
- I have felt calm and relaxed
- I have felt active and vigorous
- I woke up feeling fresh and rested
- My daily life has been filled with things that interest me
Researchers also collected daily information about sleep quality, perceived stress, mood, and energy using the same EMA approach.
Tracking Glucose Around the Clock
CGM data from the same 14 day period allowed the team to examine several measures of glucose control. These included blood sugar time below safe range (TBR: <70 mg/dl), time above safe range (TAR: >180 mg/dl), time in normal range (normoglycemia) (TING: 70-140 mg/dl), and glucose variability.
Glucose variability reflects how much a person’s blood sugar rises and falls over time.
The researchers then used statistical modeling to determine whether glucose patterns, sleep, stress, mood, and energy on one day could predict quality of life on the following day.
They also ran a separate analysis to see whether same-day measurements were associated with that day’s quality of life. The models accounted for age, sex, and diabetes type. They also included previous-day quality of life to ensure it was not strongly driving the results.
400 People With Diabetes Took Part
The analysis included data from 400 people with diabetes (72% type 1 diabetes, 28% type 2 diabetes, 55% female, age 47 years (range 32-63 years), mean glycated hemoglobin (HbA1c – a measure of blood sugar control) 7.6%.
Two glucose patterns stood out.
Spending more time in the normal glucose range on one day was significantly associated with better quality of life the next day. But more surprisingly, greater glucose variability on the previous day was also linked to higher next day quality of life.
By contrast, the amount of time participants spent above or below the safe glucose range on the previous day was not significantly associated with their quality of life the following day.
Better sleep during the preceding night was also linked to improved next day well-being. The same was true for higher energy levels on the previous day (by asking how energetic the person felt on a scale from 0 [not at all] to 10 [very much].
Interestingly, glucose measurements from the same day were not associated with quality of life on that day.
A Possible Cost of Trying to Keep Glucose Too Steady
The results do not suggest that poor glucose control is beneficial. In fact, spending more time within the normal range was associated with better quality of life.
Instead, the researchers say the finding involving glucose variability may point to a different issue. People who work especially hard to eliminate normal fluctuations may sometimes impose restrictions on themselves that make everyday life less enjoyable or make certain activities feel harder to pursue safely.
The authors say: “Days with higher time in the normal safe range for blood sugar were followed by days on which individuals with type 1 and type 2 diabetes reported better quality of life, underscoring the importance of optimal blood sugar control for well-being.
“Interestingly, higher-than-usual glucose variability was also associated with improved next-day quality of life. These findings may suggest that individuals experience lower quality of life when attempting to minimize glucose fluctuations too strictly, potentially due to the associated burden or restrictions in daily life, which may contribute to some people living with diabetes feeling unable to safely engage in certain activities.”
