title: Is Psychological Stress a Factor for Incorporation Into Future Closed-Loop Systems?
abstract: The relationship between daily psychological stress and BG fluctuations in type 1 diabetes (T1DM) is unclear. More research is needed to determine if stress-related BG changes should be considered in glucose control algorithms. This study in the usual free-living environment examined relationships among routine daily stressors and BG profile measures generated from CGM readings.
  
  
  
  A total of 33 participants with T1DM on insulin pumps wore a CGM device for 1 week and recorded daily ratings of psychological stress, carbohydrates, and insulin boluses.
  
  
  
  Within-subjects ANCOVAs found a significant relationship between daily stress and indices of BG variability/instability (r = .172 to .185, P = .011 to .018, r(2) = 2.97% to 3.43%), increased % time in hypoglycemia (r = .153, P = .036, r(2) = 2.33%) and decreased carbohydrate consumption (r = -.157, P = .031, r(2) = 2.47%). Models accounted for more variance for individuals reporting the highest daily stress. There was no relationship between stress and mean daily glucose or low/high glucose risk indices.
  
  
  
  These preliminary findings suggest that naturally occurring daily stressors can be associated with increased glucose instability and hypoglycemia, as well as decreased food consumption. In addition, findings support the hypothesis that some individuals are more metabolically reactive to stress. More rigorous studies using CGM technology are needed to understand whether the impact of daily stress on BG is clinically meaningful and if it is a behavioral factor that should be considered in glucose control systems for some individuals.
authors.affiliation: Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA Behavioral Medicine Center, University of Virginia, Charlottesville, VA, USA lag3g@virginia.edu.
authors.forename: Linda A
authors.initials: LA
authors.lastname: Gonder-Frederick
authors.affiliation: Behavioral Medicine Center, University of Virginia, Charlottesville, VA, USA.
authors.forename: Jesse H
authors.initials: JH
authors.lastname: Grabman
authors.affiliation: Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA Behavioral Medicine Center, University of Virginia, Charlottesville, VA, USA.
authors.forename: Boris
authors.initials: B
authors.lastname: Kovatchev
authors.affiliation: Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA.
authors.forename: Sue A
authors.initials: SA
authors.lastname: Brown
authors.affiliation: Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Patek
authors.affiliation: Endocrine Research Unit, Mayo Clinic, Rochester, MN, USA.
authors.forename: Ananda
authors.initials: A
authors.lastname: Basu
authors.affiliation: William Sansum Diabetes Center, Santa Barbara, CA, USA.
authors.forename: Jordan E
authors.initials: JE
authors.lastname: Pinsker
authors.affiliation: Endocrine Research Unit, Mayo Clinic, Rochester, MN, USA.
authors.forename: Yogish C
authors.initials: YC
authors.lastname: Kudva
authors.affiliation: Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA.
authors.forename: Christian A
authors.initials: CA
authors.lastname: Wakeman
authors.affiliation: William Sansum Diabetes Center, Santa Barbara, CA, USA Department of Chemical Engineering, University of California, Santa Barbara, Santa Barbara, CA, USA John A. Paulson School of Engineering and Applied Science, Harvard University, Cambridge, MA, USA.
authors.forename: Eyal
authors.initials: E
authors.lastname: Dassau
authors.affiliation: Department of Information Engineering, University of Padova, Padova, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Cobelli
authors.affiliation: Department of Chemical Engineering, University of California, Santa Barbara, Santa Barbara, CA, USA Insulet Corporation, Santa Barbara, CA, USA.
authors.forename: Howard C
authors.initials: HC
authors.lastname: Zisser
authors.affiliation: William Sansum Diabetes Center, Santa Barbara, CA, USA Department of Chemical Engineering, University of California, Santa Barbara, Santa Barbara, CA, USA John A. Paulson School of Engineering and Applied Science, Harvard University, Cambridge, MA, USA.
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Doyle
mesh_terms: D000328:Adult; D000465:Algorithms; D001786:Blood Glucose; D003922:Diabetes Mellitus, Type 1 / Q000097:blood*; D005260:Female; D006801:Humans; D007332:Insulin Infusion Systems; D008297:Male; D008875:Middle Aged; D013315:Stress, Psychological / Q000097:blood*
chemical_list: D001786:Blood Glucose
keywords: blood glucose variability; continuous glucose monitoring; psychological stress; type 1 diabetes