53-OR: Individual Sources of Diabetes Distress—A Precision Mental Health Approach Combining Ecological Momentary Assessment and Continuous Glucose Monitoring

Using n-of-1 analyses, we aimed at identifying individual sources of diabetes distress. Using ecological momentary assessment (EMA) and CGM, subjective EMA-based experiences of glucose management (hypoglycemia, hyperglycemia and glucose variability distress) and objective CGM-based markers of glucose management (time in hypo- and hyperglycemia, glucose variability) were assessed on a daily level for 17 days. Mixed-effect regression analysis with daily diabetes distress as dependent variable and daily subjective and objective markers of glucose management as random factors was performed, controlled for gender, diabetes type and study day. Individual estimates of the associations between subjective and objective markers and diabetes distress were extracted per person to identify individual sources of diabetes distress. Associations of these individual sources and psychosocial well-being 2 months later were examined. Data from 379 participants were analyzed (50.9% type 1 diabetes, 92.9% insulin therapy). Subjective experiences of glucose variability (t=14.4, p<.0001) and hyperglycemia (t=13.6, p<.0001) were the strongest predictors of daily diabetes distress while CGM-based glucose variability was not significantly associated with daily distress (t=1.13, p=0.26). Individuals for whom subjective markers were a more significant source of diabetes distress had more depressive symptoms (DS: r=0.32), more diabetes distress (DD: r=0.39), and more hypoglycemia fear (FoH: r=0.34) at follow-up (all p<.001). Individuals for whom objective markers were a more significant source of diabetes distress had more favorable psychosocial well-being at follow-up (DS: r=-0.31; DD: r=-0.33; FoH: r=-0.27; all p<.001). N-of-1 analyses demonstrated the differential effects of objective and subjective sources of diabetes distress on psychosocial well-being highlighting the need for individualized approaches.