690-P: Relationship of Diabetes Distress and Symptoms of Autonomic Nervous System Dysregulation in Type 1 Diabetes Adults

Purpose: To test the association of autonomic nervous system (ANS) dysregulation symptoms and diabetes distress (DD) in type 1 diabetes (T1D) adults. 556 US adults with self-identified T1D completed a web-based survey in May 2023, including demographics, ANS reactivity symptoms (Body Perception Questionnaire; BPQ, validated against physiologic measures), diabetes-related distress (Diabetes Distress Scale-28 T1D; DDS), depressive symptoms (PHQ-8) and anxiety (GAD-7). Mean age was 45.1 years (S.D. = 15.7), 73.2% female, 95.3% White, with a median annual household income of $60,000-100,000. Mean self-reported A1c was 6.7% (S.D. 1.0%). 72.5% reported using an insulin pump. Mean hypoglycemic episodes per week was 5.7 (9.9). Mean age at diabetes diagnosis was 20.6 years (S.D. 14.7) and mean duration of diabetes was 25.4 (S.D. 17.6) years. The sample reported high levels of comorbid hypertension (33.0%), dyslipidemia (28.6%), thyroid disorder (34.5%) and depression (28.8%). Mean total item DDS score was 2.3 (S.D. 0.8; moderate severity). The highest scores were observed in the powerlessness (mean = 3.2; S.D. 1.3), hypoglycemia distress (mean = 2.7, S.D. 1.3) and physician distress (mean = 2.4; S.D. 1.2) subscales. Mean PHQ-8 score was 6.8 (S.D. = 5.5; mild) and the mean GAD-7 score was 5.9 (S.D. 5.3, mild). BPQ mean T scores were 48.9 (S.D. 8.4) for Supradiaphragmatic and 50.6 (S.D. 8.9) for Subdiaphragmatic Reactivity subscales. Controlling for covariates, clinical categories of the DDS predicted significant differences in BPQ subscale T scores. Greatest differences in BPQ scores were observed between ‘no/little/low’ and ‘high’ distress DDS categories on all subscales (p’s <= 0.001), with ‘high’ DDS having the highest BPQ scores. Findings confirm a relationship between ANS reactivity symptoms and diabetes-related distress in adults with T1D, consistent with the Polyvagal Theory. Development of interventions that target ANS regulation to treat DD for T1D adults are needed.