Objectives: Physical symptoms (SXS) are commonly reported among adults with T2D and have a significant impact on functioning and self-management. Although there is evidence that symptom reporting is closely linked to the experience of negative affect (NA) , the directionality of this relationship remains unclear. This study used EMA to evaluate bidirectional temporal associations between SXS and NA in adults with sub-optimally controlled T2D.

Methods: Adults with T2D (N = 61; Age = 55 (10) yrs; Women = 64.5%; Black = 61%; Latino = 36%; A1C = 8.5 (2.3) completed smartphone EMA of SXS and NA 3 x daily over a 14-day period. Linear mixed effect models were used to assess associations of total number of SXS reported (0-13) and subsequent levels of NA (0-5) , and vice-versa.

Results: There were significant within- and between-person bidirectional associations between SXS and NA. Within-persons, a 1-point increase in SXS from one’s personal mean was associated with a 0.03-point increase in subsequent NA (95%CI: 0.01-0.04, p = .008) and a 1-point increase in NA from one’s personal mean was associated with a 0.39-point increase in subsequent SXS (95%CI: 0.27-0.50, p < .0001) . Between-persons, a 1-point increase in SXS personal mean was associated with a 0.18-point increase in subsequent NA (95%CI: 0.12-0.26, p < .0001) and a 1-point increase in one’s NA personal mean was associated with a 1.8-point increase in SXS (95%CI: 1.15-2.46, p < .0001) .

Conclusion: Results showed bidirectional relations between SXS and NA, observed both within- and between-persons over the course of a day, among predominantly ethnic minority adults with T2D. If these patterns reflect causal associations, they suggest that interventions that reduce negative affect would also reduce the experience of physical symptoms, and vice versa. Given prior evidence linking these factors to self-management, functioning, and health outcomes in T2D, such interventions could have substantial impact.


S.R.Fishman: None. J.S.Gonzalez: Consultant; Virta Health Corp. C.J.Hoogendoorn: None. C.Wang: None. S.A.Mulvaney: None. V.H.Jonas: None. H.Mendez-rodriguez: None. R.Fang: None. C.A.Solon: None. J.P.Crandall: Research Support; Abbott Diabetes.


NIH P30 DK111022

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