Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2017

Glycaemic variability and time-in-target and their association with diabetes-specific distress and diabetes-specific quality of life in adults with type 2 diabetes study protocol (#242)

Thomas Gladman 1 , John Furler 1 , Jo-Anne Manski-Nankervis 1 , Jane Speight 2 , Elizabeth Holmes-Truscott
  1. Department of General Practice , University of Melbourne , Melbourne , Victoria , Australia
  2. School of Psychology, Deakin University, Melbourne , Victoria , Australia

Context and Aims:

Glycaemic variability has emerged as an independent predictor of the development of complications in people with type 2 diabetes (T2D) (1)(2)(3). Time-in-target is a related measure that assesses the amount of time spent within specified target glucose ranges. Both can be assessed with retrospective continuous glucose monitoring (rCGM). Diabetes-specific distress and quality of life are important psychosocial outcomes, with known associations with average glucose (HbA1c) but little is known about their association with daily glucose fluctuations. Our aim is to explore the possible association between glycaemic variability and time-in-target with diabetes-specific distress and diabetes-specific quality of life in adults with T2D using rCGM in the primary care setting.

Methods:

Study design: The GP-OSMOTIC trial is an NHMRC-funded RCT of the effectiveness of judicious use of rCGM in people with T2D in primary care. All participants (N=300) wear an rCGM sensor (Abbott Libre Pro) for 2 weeks at baseline. We will conduct secondary analysis of baseline rCGM and questionnaire data.  

Data collection: MAGE (Mean Amplitude of Glycaemic Excursion) and time-in-target will be calculated from baseline rCGM. Participants will complete the 20-item Problem Areas of Diabetes (PAID) scale and DAWN Impact of Diabetes Profile (DIDP) to assess diabetes-specific distress and diabetes-specific quality of life respectively.

Data analysis: Hierarchical linear regression analyses will be used to explore the association between psychosocial factors and rCGM variables, adjusting for confounders, e.g. age, gender, HbA1c.

Findings:

Data collection is underway. It is hypothesised that lower diabetes-specific quality of life and greater diabetes-specific distress will be associated with greater glycaemic variability and less time-in-target.

Innovative contribution to policy, practice and/or research:

This study will provide the first evidence, and improve our understanding, of the association between glycaemic variability and psychological well-being in an Australian cohort of adults with T2D using rCGM.

  1. Brownlee M, Hirsch IB. Glycemic variability: A hemoglobin a1c–independent risk factor for diabetic complications. JAMA. 2006;295(14):1707-8.
  2. Ohara M, Fukui T, Ouchi M, Watanabe K, Suzuki T, Yamamoto S, et al. Relationship between daily and day-to-day glycemic variability and increased oxidative stress in type 2 diabetes. Diabetes Research and Clinical Practice. 2016;122:62-70.
  3. Timmons JG, Cunningham SG, Sainsbury CAR, Jones GC. Inpatient Glycemic Variability and Long-Term Mortality in Hospitalized Patients with Type 2 Diabetes. Journal of Diabetes and its Complications. 2017;31(2):479-82.