Abstract

Aims:Patients with diabetes have a reduced quality of life, especially those with high HbA1c. This study investigates if high glycaemic variability also negatively influences diabetes-related well-being. Methods:This cross-sectional observational study was conducted at the University Medical Centre Utrecht (UMCU), the Netherlands (February 2010-July 2013). Type 2 diabetes patients attending the (outpatient) clinic of the UMCU were approached to participate in a nationwide biobank study. In the UMCU, patients were also approached to participate in a local add-on study (this study), which required separate consent. Glycaemic variability was measured by continuous glucose monitoring in 124 patients with type 2 diabetes by standard deviation of glucose data from 48 hours. The Problem Areas in Diabetes Scale (PAID) was used to assess diabetes distress. Health status was assessed by 12-item short-form general health survey and EuroQaulity of life-5 dimensions visual analogue scale. Association of glycaemic variability and quality of life was analysed in the entire study population and in pre-defined subgroups (insulin treatment (n = 68); other treatment (n = 56)). Associations were investigated using linear regression. Results:A higher glycaemic variability tended to be associated (p = 0.07) with a worse PAID score in the entire study population (β0.20 (95% CI-0-01-0.42)), but this attenuated when adjusted for confounders. High glycaemic variability was associated with worse PAID score in insulin-treated patients (β0.33 (95% CI 0.01-0.65)), especially in the domains treatment-related problems (β0.29 (95% CI 0.09-0.50)) and diabetes-related emotional problems (β0.32 (95% CI 0.03-0.61)). These associations attenuated (β0.24 (95% CI 0.04-0.44); β0.24 (95% CI -0.06-0.54)) after correction for confounders and after correction for HbA1c (β0.15 (95% CI-0.07-0.38); β0.17 (95% CI-0.17-0.52)). Glycaemic variability was not consistently associated with parameters from other questionnaires. Conclusions:High glycaemic variability was associated with diabetes distress albeit not independent of HbA1c. Since this association was found in insulin-treated type 2 diabetes patients only; glycaemic variability could be a potential treatment goal for this particular group.

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