Time-varying psychosocial influences of blood glucose among adults with type 1 diabetes - PROJECT SUMMARY/ABSTRACT Type 1 diabetes is an exceptionally challenging disease to manage, requiring a host of complex behaviors to manually regulate one’s blood glucose. Importantly, these disease management behaviors must be responsive to the ever-changing needs of one’s day-to-day environment; thus, one’s diabetes management must be fundamentally adaptive. While the psychological burden of diabetes is well documented, investigations into the implications of psychosocial factors like mood, stress, and social relationships on blood glucose have tended to focus on broad cross-sectional or between-person findings. However, research has failed to adequately capture how these psychosocial factors impact blood glucose in real-time (e.g., day-to-day or hour-to-hour), and thus have limited implications for interventions to reduce disease burden. The proposed research will address this gap by combining ecological momentary assessments (EMAs) with continuous glucose monitoring (CGM) data among 50 adults with type 1 diabetes. Participants will complete six brief surveys per day for fourteen days, reporting on mood, diabetes-specific and overall stress, the quality of their social interactions, self-care behaviors, food intake, energy expenditure, and insulin dosing. Given recent surges in CGM use, blood glucose data will be downloaded from participants’ existing devices; the mean, coefficient of variation, and time in, above, and below range will be calculated across the two hours following each EMA. Aim 1 will identify links of mood, diabetes distress, and overall stress to blood glucose outcomes across the subsequent two hours. It is hypothesized that negative mood and stress will lead to worse glucose outcomes, while positive mood will lead to better glucose outcomes. For links that are supported, self-care will be investigated as a potential mechanism underlying these relations. Aim 2 will examine the effects of conflictual and supportive social interactions on blood glucose. It is hypothesized that conflictual interactions will lead to poor glucose outcomes, while supportive interactions will lead to improved glucose outcomes. Again, self-care will be investigated as a mediator for any observed links. Exploratory Aim 3 will investigate whether within-person links of these psychosocial factors to blood glucose differ based on gender and overall relationship quality. It is hypothesized that females will overall show stronger relations than males, and that higher quality relationships will buffer against the negative effects of conflictual interactions. This research will contribute to our understanding of the real-time barriers to diabetes care, paving the way for just-in-time interventions to improve disease outcomes. In support of this project, the Principal Investigator will collaborate with a team of leaders in the field. This mentorship team will facilitate additional training opportunities in the patient experience of diabetes and CGM use, the endocrine functions underlying diabetes and blood glucose regulation, and the quantitative methods required for dense CGM data. Ultimately, the training plan and proposed research will enable the PI to establish her future career as a researcher at the intersection of diabetes and digital health.
