Webinar Series: Digital Methods in Behavioral Research #2

The Relationship of Mental Co-morbidities with Glycemic Control in People with Diabetes Mellitus

Negative interrelationships between diabetes and depression/affective comorbidity with potentially impaired self-management and glucose control, as well as increased risks of long-term complications in affected people, have been in the focus of psychological diabetes research for several decades. Although elevated risks of vascular complications were established in those with T2DM and co-morbid depression, and some evidence suggests the same for T1DM too, the pathways mediating affective problems into adverse long-term health outcomes are not sufficiently understood. Generally, behavioral (i.e. less optimal health behavior and glucose management in those with depression leading to less optimal glycemic and health outcomes) and biological pathways (i.e. physiological mechanisms such as chronic systemic inflammation and stress reactivity/HPA axis activation affecting glucose metabolism and/or creating pathogenic effects on cells and tissues) are discussed.

Studies have mostly focussed on associations between co-morbid affective conditions in T1DM/T2DM with self-management behavior and glycemic outcome (HbA1c). However, the evidence is not conclusive with diverse and inconsistent findings across studies and study populations (e.g. T1DM/T2DM etc.). It appears that a more precise, micro-analytic approach analyzing the interrelationship between mood and glucose over time – including the mediating behavioral and physiological mechanism – may be required for better understanding impacts of co-morbid affective conditions on diabetes-related health outcomes.

The DIA-LINK study is a prospective observational study of affective co-morbidities in T1DM making use of ecological momentary assessment (EMA) of moods, stress aspects and diabetes problems in daily life as well as other important variables regarding depression and/or diabetes-specific distress. Participants were assessed using the mEMA app up to four times daily over four weeks while glucose levels were simultaneously collected using a continuous glucose monitoring (CGM) system.

Additionally, heart rate and activity measures were collected via a wearable tracker. The participants were enrolled based on their affiliation to groups of people with or without elevated depressive symptoms (CES-D score ≥ 22) and/or diabetes distress (PAID score ≥ 40) at baseline; this way a 2×2-group comparison design was developed, warranting that people with none, either one solely or both affective conditions are included in the sample. A follow-up assessment of long-term glucose control (HbA1c) and psychological outcomes (assessed using standard questionnaires) three month after baseline completes the data collection. The data collection was finished in July 2020, and the analyses have now begun.

The webinar presentation shall inform about the study aims and methods using EMA assessment and activity tracking using the mEMA app as well as CGM of glucose levels in diabetes. Preliminary data from the first DIA-LINK study will be presented to provide an understanding of this new research approach in the field of diabetes psychology.

Andreas Schmitt, PhD

Research Institute of the Diabetes Academy Mergentheim, Diabetes Center Mergentheim (DZM), Germany.

Andreas Schmitt is a post-doctoral researcher at the Research Institute of the Diabetes Academy Mergentheim, Diabetes Center Mergentheim (DZM), Germany.

Research interests include affective conditions and distress in T1 and T2 diabetes; psychological factors re diabetes self-care and health behavior; treatment programs for depression and distress; PROMs.

He is also affiliated with the German Center for Diabetes Research (DZD) and the Dpt. of Clinical Psychology, Ulm University.