Hypoglycaemia induces emotional disruption

The impact of hypoglycaemia on daily functioning among adults with diabetes: a prospective observational study using the Hypo-METRICS app

AIMS/HYPOTHESIS

The aim of this work was to examine the impact of hypoglycaemia on daily functioning among adults with type 1 diabetes or insulin-treated type 2 diabetes, using the novel Hypo-METRICS app.

METHODS

For 70 consecutive days, 594 adults (type 1 diabetes, n=274; type 2 diabetes, n=320) completed brief morning and evening Hypo-METRICS 'check-ins' about their experienced hypoglycaemia and daily functioning. Participants wore a blinded glucose sensor (i.e. data unavailable to the participants) for the study duration. Days and nights with or without person-reported hypoglycaemia (PRH) and/or sensor-detected hypoglycaemia (SDH) were compared using multilevel regression models.

RESULTS

Participants submitted a mean ± SD of 86.3±12.5% morning and 90.8±10.7% evening check-ins. For both types of diabetes, SDH alone had no significant associations with the changes in daily functioning scores. However, daytime and night-time PRH (with or without SDH) were significantly associated with worsening of energy levels, mood, cognitive functioning, negative affect and fear of hypoglycaemia later that day or while asleep. In addition, night-time PRH (with or without SDH) was significantly associated with worsening of sleep quality (type 1 and type 2 diabetes) and memory (type 2 diabetes). Further, daytime PRH (with or without SDH), was associated with worsening of fear of hyperglycaemia while asleep (type 1 diabetes), memory (type 1 and type 2 diabetes) and social functioning (type 2 diabetes).

CONCLUSIONS/INTERPRETATION

This prospective, real-world study reveals impact on several domains of daily functioning following PRH but not following SDH alone. These data suggest that the observed negative impact is mainly driven by subjective awareness of hypoglycaemia (i.e. PRH), through either symptoms or sensor alerts/readings and/or the need to take action to prevent or treat episodes.

Identification of factors associated with fear of hypoglycemia using the capability, opportunity, motivation and behavior model in people with type 2 diabetes mellitus: a cross-sectional study

AIMS

To examined the relationship between fear of hypoglycemia and certain variables in people with type 2 diabetes mellitus (T2DM) based on the Capability, Opportunity, Motivation, and Behavior model, combined with the context unique to people with diabetes to provide a basis for developing targeted nursing interventions.

METHODS

In this cross-sectional study, 212 people with T2DM were recruited from February 2021 to July 2021. Data were collected using the Hypoglycaemia Fear Survey, Gold score, Patient Assessment of Chronic Illness Care (PACIC) scale and Diabetic Self-Management Attitudes Scale. Multiple linear regression analysis was performed to determine the predictors of fear of hypoglycemia using SPSS 26.0.

RESULTS

The mean fear of hypoglycemia score was 74.88 ± 18.28 (range: 37.00-132.00). In people with T2DM, the frequency of blood glucose monitoring, the frequency of hypoglycemia in the past half-year, degree of understanding of hypoglycemia, impaired awareness of hypoglycemia, PACIC, and self-management attitude of diabetes were the influencing factors of fear of hypoglycemia (adjusted R2 = 0.560, F[21,190] = 13.800, P < 0.001). These variables explained 56.0% of the variance in the fear of hypoglycemia.

CONCLUSIONS

The level of fear of hypoglycemia in people with T2DM was relatively high. In addition to paying attention to the disease characteristics of people with T2DM, medical staff should also pay attention to patients' own perception and handling ability of disease and hypoglycemia, attitude toward self-management behavior and external environment support, all of which have a positive effect on improving the fear of hypoglycemia in people with T2DM, optimizing the self-management level and improving quality of life.

Maternal Diet Quality and Prenatal Depressive Symptoms: The Moderating Role of Economic Well-Being

Prenatal depression is prevalent and adversely impacts maternal and infant health. This study addresses a critical literature gap and investigates the association between maternal diet quality and prenatal depressive symptoms, as well as the moderating effect of economic well-being on this link. A cross-sectional design was used, including 43 healthy pregnant women in the second trimester aggregated from two research projects. Prenatal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale. Dietary quality was evaluated using two non-consecutive 24 h dietary recalls, from which the Adapted Dietary Inflammatory Index (ADII) and the Healthy Eating Index (HEI)-2015 were derived. Economic well-being was indicated by the income-to-poverty ratio. A higher HEI-2015 (adherence to dietary guidelines; β = -0.53, p = 0.01) and negative ADII (anti-inflammatory diet; β = 0.40, p = 0.06) were associated with fewer prenatal depressive symp-toms. Among pregnant women with worse economic well-being, a pro-inflammatory diet was as-sociated with more prenatal depressive symptoms (b = 1.69, p = 0.004), but among those with better economic well-being, the association was not significant (b = 0.51, p = 0.09). Dietary interventions aimed at reducing dietary inflammation might hold some promise for improving mental health among pregnant women who are economically vulnerable.

The Impact of Free Sugar on Human Health-A Narrative Review

The importance of nutrition in human health has been understood for over a century. However, debate is ongoing regarding the role of added and free sugars in physiological and neurological health. In this narrative review, we have addressed several key issues around this debate and the major health conditions previously associated with sugar. We aim to determine the current evidence regarding the role of free sugars in human health, specifically obesity, diabetes, cardiovascular diseases, cognition, and mood. We also present some predominant theories on mechanisms of action. The findings suggest a negative effect of excessive added sugar consumption on human health and wellbeing. Specific class and source of carbohydrate appears to greatly influence the impact of these macronutrients on health. Further research into individual effects of carbohydrate forms in diverse populations is needed to understand the complex relationship between sugar and health.

Glucose variability and mood in adults with diabetes: A systematic review

Aims

To systematically review the literature regarding the association between glucose variability (GV) and mood in adults with diabetes, appraise the used methods and make suggestions for future research.

Methods

A systematic review of literature published up to May 2019 was performed. Abstracts and full texts were screened independently in duplicate. Experimental and observational studies reporting the association between GV and mood in adults with type 1 diabetes or type 2 diabetes were evaluated. A descriptive analysis of the extracted data was conducted, along with a quality assessment.

Results

Out of the 2.316 studies screened, eight studies met our criteria. Studies used a variety of measures and metrics to determine GV and mood. Four studies used continuous glucose monitoring (CGM). An association between GV and mood was found in four studies when correlating either postprandial glucose rate of increase with current mood or multiday GV with mood measured retrospectively. The other four studies did not find any association.

Conclusions

There is no clear empirical support for a link between GV and mood in adults with type 1 and type 2 diabetes. More rigorous research is warranted using CGM and ecological momentary assessment of mood to assess if and under what conditions an association between GV and mood exists.

Cognitive, behavioural and psychological barriers to the prevention of severe hypoglycaemia: A qualitative study of adults with type 1 diabetes

OBJECTIVES

Severe hypoglycaemia affects approximately one in three people with type 1 diabetes and is the most serious side effect of insulin therapy. Our aim was to explore individualistic drivers of severe hypoglycaemia events.

METHODS

In-depth semi-structured interviews were conducted with a purposive sample of 17 adults with type 1 diabetes and a history of recurrent severe hypoglycaemia, to elicit experiences of hypoglycaemia (symptoms/awareness, progression from mild to severe and strategies for prevention/treatment). Interviews were analysed using an adapted grounded theory approach.

RESULTS

Three main themes emerged: hypoglycaemia-induced cognitive impairment, behavioural factors and psychological factors. Despite experiencing early hypoglycaemic symptoms, individuals often delayed intervention due to impaired/distracted attention, inaccurate risk assessment, embarrassment, worry about rebound hyperglycaemia or unavailability of preferred glucose source. Delay coupled with use of a slow-acting glucose source compromised prevention of severe hypoglycaemia.

CONCLUSION

Our qualitative data highlight the multifaceted, idiosyncratic nature of severe hypoglycaemia and confirm that individuals with a history of recurrent severe hypoglycaemia may have specific thought and behaviour risk profiles. Individualised prevention plans are required, emphasising both the need to attend actively to mild hypoglycaemic symptoms and to intervene promptly with an appropriate, patient-preferred glucose source to prevent progression to severe hypoglycaemia.

NON-INVASIVE NOCTURNAL HYPOGLYCEMIA DETECTION FOR INSULIN-DEPENDENT DIABETES MELLITUS USING GENETIC FUZZY LOGIC METHOD

Hypoglycemia, or low blood glucose, is the most common complication experienced by Type 1 diabetes mellitus (T1DM) patients. It is dangerous and can result in unconsciousness, seizures and even death. The most common physiological parameter to be effected from hypoglycemic reaction are heart rate (HR) and correct QT interval (QTc) of the electrocardiogram (ECG) signal. Based on physiological parameters, a genetic algorithm based fuzzy reasoning model is developed to recognize the presence of hypoglycemia. To optimize the parameters of the fuzzy model in the membership functions and fuzzy rules, a genetic algorithm is used. A validation strategy based adjustable fitness is introduced in order to prevent the phenomenon of overtraining (overfitting). For this study, 15 children with 569 sampling data points with Type 1 diabetes volunteered for an overnight study. The effectiveness of the proposed algorithm is found to be satisfactory by giving better sensitivity and specificity compared with other existing methods for hypoglycemia detection.

[Quality of life and degree of control in type 2 diabetics seen in primary care]

OBJECTIVE

To analyse the health-related quality of life (HRQL) of type 2 diabetic patients (DM2) and to study the possible influence of this on the metabolic control of the disease and the associated diseases.

MATERIAL AND METHODS

Cross-sectional descriptive study of HRQL using a general questionnaire with COOP/WONCA cartoons and evaluation of compliance with the control criteria.

RESULTS

A total of 98 patients with an average age of 72.9+/-9.9 years were studied, of which a total of 44.8% had a total score of <15 in the questionnaire. In the "overall health" dimension, 64.2% scored it between good and excellent. Almost 70% showed that they did not have physical or emotional health limitation in their social activities, and 42.9% had not suffered any pain in the previous two weeks. A total of 57.1% did not have difficulty when carrying out normal activities or tasks, and 55% said that they could only do light or very light physical activity for 2 minutes. Degree of control: 50% HbA(1c) <7%; 68.4% total cholesterol <200 mg/dl; 26.5% LDL-cholesterol <100 mg/dl; 69.4% HDL-cholesterol >40 mg/dl; 86.7% triglycerides <150 mg/dl; 51% blood pressure (BP) <130/80 mmHg and 90.8% did not smoke. Only 9.1% simultaneously fulfil the objectives for BP, LDL-cholesterol and HbA(1c). We did not find any relationship between the total score obtained in the questionnaire and age, the number of associated DM2 diseases or the number of control criteria accomplished or differences between the average values of the total score of the questionnaire and the gender of the patient.

CONCLUSION

The HRQL and the degree of DM2 control in our patients can be considered good. We did not identify factors related to the control that influence their quality of life.

How does anger coping style affect glycemic control in diabetes patients?

BACKGROUND

Although various forms of anger have been found to influence the psychological and physical health in many chronic illness populations, little is known about the effects of anger in diabetes patients.

PURPOSE

Associations between anger coping style, diabetes-related psychological distress, and glycosylated hemoglobin (HbA1c) were examined in 100 diabetes patients.

METHOD

Participants completed the Problem Areas in Diabetes and Coping Styles questionnaires, and had HbA1c assessments at study entry (Time 1 = T1), six months (T2), and 12 months after T1 (T3).

RESULTS

Linear regression analyses revealed T1 anger coping associated with T3 HbA1c (beta = .22, p < .05), but T1 HbA1c did not associate with T3 anger coping (beta = .13, p = NS). After controlling for significant covariates (of gender, age, education, type and duration of diabetes), regression analyses revealed that T2 diabetes-related psychological distress partially mediated this association.

CONCLUSION

These results suggested that higher levels of anger coping may promote poorer glycemic control in diabetes patients by provoking greater diabetes-related distress. Areas of future research on this topic are discussed.

beta-blocker use and diabetes symptom score: results from the GEMINI study

AIM

The Glycemic Effect in Diabetes Mellitus: Carvedilol-Metoprolol Comparison in Hypertensives (GEMINI) trial compared the metabolic effects of two beta-blockers in people with type 2 diabetes and hypertension treated with renin-angiotensin system (RAS) blockade and found differences in metabolic outcomes. In this paper, we report the results of a prespecified secondary analysis of GEMINI that sought to determine the effect of these two beta-blockers on commonly reported symptoms.

METHODS

The Diabetes Symptom Checklist (DSC), a self-report questionnaire measuring the occurrence and perceived burden of diabetes-related symptoms, was completed by GEMINI participants at baseline and at the end of the study (maintenance month 5). The DSC assessed symptoms in eight domains: psychology (fatigue), psychology (cognitive), neuropathy (pain), neuropathy (sensory), cardiology, ophthalmology, hyperglycaemia and hypoglycaemia.

RESULTS

Comparison of the mean change in self-reported diabetes-related symptoms indicated a significant treatment difference favouring carvedilol over metoprolol tartrate in overall symptom score (-0.08; 95% CI -0.15, -0.01; p = 0.02) and in the domains for hypoglycaemia symptoms (-0.12; 95% CI -0.23, -0.02; p = 0.02) and hyperglycaemia symptoms (-0.16; 95% CI -0.27, -0.05; p = 0.005). Carvedilol resulted in fewer perceived diabetes-related symptoms in patients with diabetes and hypertension.

CONCLUSION

Carvedilol resulted in a lower perceived burden of diabetes-related symptoms in patients with type 2 diabetes and hypertension. The addition of a well-tolerated beta-blocker to RAS blockade may improve hypertension treatment and quality of life in patients with diabetes.

FL, Navarro F, Uchida MC, Bacurau RFP. Suplementação de carboidrato não reverte o efeito deletério do exercício de endurance sobre o subseqüente desempenho de força

Estudos disponíveis na literatura demonstram que a realização prévia de um exercício de endurance afeta de modo adverso o desempenho no exercício de força subseqüente. Tal ocorrência pode estar relacionada a mudanças metabólicas induzidas pelo exercício de endurance. O objetivo deste trabalho foi verificar se a ingestão de carboidrato (CHO) pode atenuar os efeitos de uma sessão aguda de exercício de endurance sobre o desempenho de força. A fim de testar essa hipótese, seis estudantes universitárias (164 ± 5,9cm; 64,9 ± 7,2kg), com experiência em treinamento de força, foram submetidas a um teste para a determinação do VO2pico (44 ± 4,3ml.min-1) e um teste de 1-RM para o leg press (186 ± 22,5kg) seguido de um teste de repetições máximas (duas séries de leg press realizado a 70% de 1-RM até exaustão 1ª série 21 ± 2,6 e 2ª série 11 ± 1,9 repetições) em dias diferentes. Seguindo um protocolo duplo-cego, os sujeitos foram submetidos a duas condições experimentais, recebendo uma bebida placebo (P) ou outra contendo carboidrato (6% - maltodextrina), antes (500ml) e durante (500ml) a realização de uma sessão de exercício de endurance (corrida em esteira 70% do VO2pico por 45 minutos). Em seguida ao exercício de endurance, os indivíduos realizaram um teste de 1-RM seguido pelo teste de repetições máximas. Não foram observadas mudanças no teste de 1-RM e na concentração plasmática de glicose entre as condições experimentais (P x CHO). O número de repetições máximas a 70%-1RM apresentou decréscimo nas duas situações (P 1ª série 13 ± 2,9 repetições e 2ª série 6 ± 2,1 repetições; CHO 1ª série 15 ± 2,5 repetições e 2ª série 7 ± 1,7 repetições, p < 0,05), não havendo diferença entre ambas. Uma sessão de exercício de endurance (intensidade moderada e longa duração) realizada previamente afeta de modo negativo a capacidade de realizar repetições máximas. Independente do mecanismo envolvido na redução do número de repetições máximas, o consumo de carboidrato foi incapaz de reverter esse efeito prejudicial.

Emotional changes during experimentally induced hypoglycaemia in type 1 diabetes

Emotional changes during experimentally induced hypoglycaemia in type 1 diabetic patients were investigated using a hyperinsulinaemic glucose clamp. In the experimental group (n=11), blood glucose was stabilised at euglycaemia (5.6 mmol/l, phase 1), then lowered to 2.5 mmol/l (phase 2) and raised to 5.6 mmol/l (phase 3). In the control group (n=11), euglycaemia was maintained during all phases. Hypoglycaemia elicited the expected endocrine, symptomatic and neuroglycopenic effects. During hypoglycaemia negative mood states increased significantly, whereas positive mood states decreased. Hypoglycaemia prolonged rating time of emotional stimuli (drawn from IAPS) significantly. The arousal ratings of the slides were higher during hypoglycaemia. Valence and dominance ratings were not affected. Epinephrine and norepinephrine release correlated with a higher arousal rating and a decrease in positive mood states. Deterioration in neuropsychological tasks correlated with an increase in negative mood states. Experimental induction of hypoglycaemia can offer a new research model to study emotional processes.

The emotions of adults with diabetes: a comparison across race

Diabetes is a disease with menacing complications and demanding treatment regimes that confront those afflicted throughout their lives. Emotions are common responses to disease and illness. Unfortunately, few studies explore the emotions adults experience while living with diabetes. This qualitative study sought to identify the ordinary (non-pathological) emotions, specify their sources (causes, stimuli), and the effect of race on these experiences. A total of 76 emotions from 38 different sources were described by 34 subjects. Race influenced both the quality and quantity of the emotions. The length of time with diabetes, the number of complications reported, and the subjects' rating for diabetes self-management success also influenced emotion experiences.

Prevalence of somatic indicators of distress in diabetes patients: comparison to psychiatric patients and community nonpatients

OBJECTIVE

Because psychiatric screening methods are usually developed using psychiatric samples but not medical samples, they often include distress indicators that overlap with medical illness. This potentially inflates psychopathology estimates for medically ill patient groups. The objective of this study was to determine whether somatic distress indicator base rates are elevated in diabetes patients.

METHOD

The occurrence of Symptom Checklist 90-R (SLC-90-R) somatic symptoms was studied in fifty-six diabetes mellitus patients (27 insulin dependent, 29 non-insulin dependent) with non-elevated SLC-90-R profiles, as compared to both community nonpatient and psychiatric patient norms.

RESULTS

Of the fifteen SCL-90-R items rated by endocrinologists as most likely to be diabetes-related, nine were endorsed more frequently by diabetes patients than by nonpatients: faintness/dizziness (endorsed by 36% of diabetics), reduced libido (endorsed by 41%), anenergia (68%), memory problems (66%), trembling (18%), numbness (55%), weakness (39%), overeating (59%), and somatic concerns (41%). Anergia and faintness/dizziness were endorsed more frequently by psychiatric patients than diabetes patients, whereas numbness was endorsed more often by diabetes patients.

CONCLUSIONS

Conservatism is warranted when applying these somatic indicators of distress to diabetes patients. Further studies are needed to determine whether such illness overlap biases case classification.