Abstract
Managing type 1 diabetes is stressful. Stress physiology influences glucose metabolism. Continuous glucose monitors allow us to track glucose variability in the real-world environment. Managing stress and cultivating resiliency should improve diabetes management and reduce glucose variability. The study was designed as a randomized prospective cohort pre-post study with wait time control. Participants were adult type 1 diabetes patients who used a continuous glucose monitor and recruited from an academic endocrinology practice. The intervention was the Stress Management and Resiliency Training (SMART) program conducted over 8 sessions over web-based video conference software. The main outcome measures were Glucose variability, the Diabetes Self-Management questionnaire (DSMQ),Short-Form Six-Dimension (SF-6D), and the Connor-Davidson Resiliency (CD-RSIC) instrument. There was statistically significant improvement in participants DSMQ and CD RISC scores though the SF-6D did not change. Participants under age 50 years-old showed a statistically significant reduction in average glucose (p = .03) and Glucose Management Index (GMI) (p = .02). Participants also had reduced percentage of time high and increased time in range though this did not reach statistical significance. The participants found doing the intervention online acceptable if not always ideal. An 8-session stress management and resiliency training program reduced diabetes related stress and improved resiliency and reduced average blood glucose and GMI in those under 50 years-old. ClinicalTrials.gov, identifier NCT04944264.
Highlights
IntroductionDiabetes is a chronic illness that relies on self-care
Even patients with sensor directed insulin pumps must make the decisions about meal dosing several times a day
We hypothesized that the course on videoconferencing platform would deliver similar effects on quality of life as has been seen in the past from on-site courses, and that the intervention would reduce glucose variability and improve resiliency
Summary
Diabetes is a chronic illness that relies on self-care. Exercise, and dose of medication must be made multiple times a day. In Type 1 diabetes, the patient provides all or most the insulin required to control their metabolism, placing greater emphasis on correct medication decisions than in type 2 diabetes. Even patients with sensor directed insulin pumps must make the decisions about meal dosing several times a day. Patients with Type 1 diabetes must balance these self-care requirements with the usual stressors of daily life. Several studies have documented decreased quality of life for people with Type 1 diabetes when compared to those without diabetes. Diabetes specific measures of quality of life show direct associations of worsening life quality with worsening control or presence of diabetes-related complications [1–3]
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