Visual Abstract

Low and high glucose levels can cause diabetes-specific aversive symptoms. These symptoms can be a direct marker of the impact of diabetes on living with the disease. We used Ecological Momentary Analysis (EMA) in combination with a flash glucose meter (Freestyle Libre, Abbott) to assess the impact of glucose levels on symptoms. We selected symptoms typically associated with high and low glucose levels, as well as control symptoms. In the DIA-LINK study, 203 people with type 1 diabetes were asked to rate the severity of diabetes symptoms on a “0” to “10” scale four times a day over a two-day period. Two measurement points were fixed (morning and evening) and two were randomly assigned. Glucose data from the 2-hour period before each symptom assessment were extracted. Multilevel regression analysis was used to determine the difference between 2-hour periods with low or high glucose values (glucose value < 70 mg/dl or > 250 mg/dl, respectively) and without such hypoglycemic or hyperglycemic periods. Figure shows T values (values > 1.96 = p < 0.05) as a measure of effect size for the discriminative ability of symptoms to detect hypoglycemic and hyperglycemic glucose levels. There appears to be a clear association between low and high glucose levels and specific diabetes symptoms. These associations can be used to develop patient-reported outcome measures capable of assessing the direct impact of glycemic control or diabetes treatment on diabetes symptoms.


N. Hermanns: Advisory Panel; Self; Abbott, Research Support; Self; Berlin-Chemie AG, Roche Diabetes Care, Sanofi-Aventis Deutschland GmbH. A. J. Schmitt: None. B. Kulzer: Advisory Panel; Self; Berlin-Chemie AG, Roche Diabetes Care, Sanofi-Aventis Deutschland GmbH, Research Support; Self; Berlin-Chemie AG, Novo Nordisk, Speaker’s Bureau; Self; Berlin-Chemie AG, Dexcom, Inc., Novo Nordisk. L. Priesterroth: None. D. Ehrmann: Speaker’s Bureau; Self; Berlin-Chemie AG.


German Center for Diabetes Research (DZD)

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