Anyone who lives with diabetes, or cares for someone who does, knows how much effort goes into keeping blood sugar on an even keel. New research offers a gentle and rather reassuring thought: a day with a few more ups and downs, provided glucose stays within safe limits, may be followed by a better one.
The findings come from the PRO-MENTAL study and were prepared for the Annual Meeting of the European Association for the Study of Diabetes (EASD), which runs in Milan from 28 September to 2 October.
The research was conducted by Professor Dominic Ehrmann of FIDAM, the Research Institute Diabetes Academy Mergentheim in Bad Mergentheim, Germany, and colleagues. The study was funded by the German Center for Diabetes Research (DZD), according to the EASD's summary of the work.
What the researchers did
The analysis included data from 400 people with diabetes. Of those, 72% had type 1 diabetes and 28% had type 2, and 55% were women. The age given for the group was 47, with a range of 32 to 63.
Every day for 14 consecutive days, participants rated their quality of life using questions based on the WHO-5 questionnaire. It asks people to rate five statements, including "I have felt cheerful and in good spirits" and "I woke up feeling fresh and rested".
They also recorded their sleep quality, stress, mood and energy each day.
Over the same fortnight, continuous glucose monitoring (CGM) devices tracked their glucose around the clock. The team looked at time spent below the safe range (under 70 mg/dl, roughly 3.9 mmol/L), time above it (over 180 mg/dl, roughly 10 mmol/L) and time in the normal range (70 to 140 mg/dl, roughly 3.9 to 7.8 mmol/L).
They also measured glucose variability, which reflects how much a person's blood sugar rises and falls over time.
The researchers then used statistical modelling to see whether one day's glucose patterns, sleep, stress, mood and energy could predict quality of life the following day. Their models accounted for age, sex and diabetes type, as well as how people had rated their quality of life the day before.
What they found
Two patterns stood out. Spending more time in the normal glucose range on one day was significantly associated with better quality of life the next day.
More surprisingly, greater glucose variability on the previous day was also linked to higher quality of life the next day.
By contrast, time spent above or below the safe range on the previous day was not significantly associated with how people felt the following day. Nor were glucose measurements associated with quality of life on the same day.
Sleep and energy featured too. Better sleep the night before, and higher energy levels the previous day, were both linked to improved wellbeing.
What it means, and what it doesn't
The results do not suggest that poor glucose control is beneficial, the EASD summary stresses. Time in the normal range was itself tied to better days.
Instead, the researchers suggest that people who work especially hard to eliminate normal fluctuations may sometimes place restrictions on themselves that make everyday life less enjoyable.
The authors say: "Days with higher time in the normal safe range for blood sugar were followed by days on which individuals with type 1 and type 2 diabetes reported better quality of life, underscoring the importance of optimal blood sugar control for well-being."
They add: "Interestingly, higher-than-usual glucose variability was also associated with improved next-day quality of life. These findings may suggest that individuals experience lower quality of life when attempting to minimize glucose fluctuations too strictly, potentially due to the associated burden or restrictions in daily life, which may contribute to some people living with diabetes feeling unable to safely engage in certain activities."
A word of caution
Some care is needed. This study shows an association, not proof of cause: it cannot tell us that fluctuating glucose makes anyone feel better, only that the two tended to go together.
It is also a conference presentation, covering 14 days in 400 people, most of whom had type 1 diabetes. The EASD summary does not say whether the work has been peer reviewed or published in full.
Most importantly, this is not medical advice. Please do not change how you manage your glucose on the strength of this study without first talking to your diabetes care team, who know your circumstances and your targets.
