Even the people with type 1 diabetes who regularly meet recommended blood sugar guidelines can have a few rough days when their levels rise higher than usual. Life happens, and an unexpected illness, a stressful week at work, a carb-heavy family reunion – all these events can increase glycemic variability.
Type 1 diabetes research has often focused on blood sugar management in terms of HbA1c but less so regarding time in range, specifically the amount of glycemic variability each person experiences. Specifically, those who have HbA1c values closer to targets are not as often the focus of research, but that may soon change.There is growing understanding among researchers that glycemic variability may have a larger-than-previously-understood impact among the quality of life of these patients.
A new study undertaken by researchers with T1D Exchange and Tidepool provides some data on how blood glucose levels over 140 mg/dL can have a significant impact on the quality of life of even those with well-managed type 1 diabetes. The findings were presented at the American Diabetes Association 79th Scientific Sessions in San Francisco.
For the study, 71 people with type 1 diabetes who used continuous glucose monitors (CGMs) were recruited through T1D Exchange Glu, an online community for people with type 1 diabetes. Each answered an online survey and uploaded data from their CGMs to the Tidepool site. The data and the answers were then analyzed by researchers.
Researchers first determined that the participants had an average HbA1c of 6.5%, lower than the ADA recommended target of 7.0% in adults. They also found that this group defined what constitutes high blood sugar levels differently with 65% of the population considering something below 180 mg/dL at high blood sugar; the researchers adjusted the threshold to 140 mg/dL or higher, rather than the standard of 180 mg/dL.
With this in mind, they then looked at the participants’ answers about how they viewed their quality of life in the past week. Comparing these answers with CGM data, the researchers discovered that the more times the participants had blood sugar levels over 140 mg/dL, the more likely they were to report a poorer quality of life in the past week or two weeks. In fact, those who had 24 or more instances of blood sugar levels over 140 mg/dL had a 83 percent increased risk of poorer quality of life within the week compared to those with fewer than 24 events over 140 mg/dL. This pattern continued when looking at data for two weeks, those with 48 or more events over 140 mg/dL also had an 83% increased risk of poor QOL compared to those with fewer than 48 events over 140 mg/dL.
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T1D Exchange Data Analyst Colleen Garey, MS, said findings like this suggest that when it comes to recommended glucose targets, one size fits all may not be best.
“Glucose excursions that are traditionally thought of as mild or moderate are less common in this population, with several patients experiencing no events above 250 mg/dL, therefore it may be valuable to look at a novel cut-off for these patients,” Garey said.
You can read more about T1D Exchange-related research at the ADA 79th Scientific Sessions here.