"Hyperglycemia aversiveness": Investigating an overlooked problem among adults with type 1 diabetes.

AIMS: To investigate the problem of adults with type 1 diabetes (T1D) who purposefully keep their glucose levels low, and to explore contributors to, and possible impact of, this potentially dangerous phenomenon. METHODS: We developed three self-report items as a means to identify individuals who endorse a consistent preference for hypoglycemia over hyperglycemia ("Hyperglycemia Aversives"). In a large T1D survey (n = 219), validated measures of well-being, emotional distress and hypoglycemic awareness, and glycemic metrics derived from the past 14-day period, were used to examine whether Hyperglycemia Aversives could be characterized as a distinct group. RESULTS: Hyperglycemia Aversives comprised 16.4% of the sample. This unique group demonstrated significantly higher mean %TIR (71.6% vs. 63.6%) and %TBR (5.1% vs. 2.2%), lower mean %TAR > 250 mg/dL (6.0% vs. 10.1%), and higher rates of impaired hypoglycemic awareness and recurrent severe hypoglycemia episodes than the remaining study sample ("Non-Aversives") (all ps < 0.01). The two groups did not demonstrate significant differences on psychosocial outcomes. CONCLUSIONS: We identified a group of T1D adults reporting a consistent preference for hypoglycemia over hyperglycemia. These individuals achieve significantly greater %TIR and less %TAR, but at the cost of greater %TBR and more frequent severe hypoglycemia episodes.

The influence of time in range on daily mood in adults with type 1 diabetes.

AIMS: To investigate the impact of time in range (TIR) on mood in adults with type 1 diabetes (T1D). METHODS: We followed a cohort of 219 T1D adults, all currently employing a real-time continuous glucose monitoring system (RT-CGM), to investigate how daily changes in CGM metrics were associated with nightly reports of positive and negative mood over a two-week period. RESULTS: Greater daily %TIR (70-180 mg/dL) and less time in "severe" hyperglycemia (% time above range (TAR) > 300 mg/dL) were both significantly associated with higher ratings on all positive mood elements and lower ratings on most negative mood elements (all ps < 0.05). When entered together as predictors, %TIR but not %TAR >300 emerged as an independent predictor of many of the positive and negative mood variables. Neither daily changes in time spent in hypoglycemia (< 70 mg/dL) nor glycemic variability (represented by the coefficient of variation) were significantly related to reported mood. CONCLUSIONS: This study provides the first evidence that time in range (%TIR) is associated with, and likely enhances, daily mood. Consistent with previous studies, we also found that more time spent in "severe" hyperglycemia is linked to more negative mood.

Satisfaction with life among veterans with spinal cord injuries completing multidisciplinary rehabilitation.

STUDY DESIGN: This is a single-group, retrospective study. OBJECTIVES: The objective of this study was to understand the factors contributing to satisfaction with life (SWL) among veterans with a spinal cord injury (SCI) completing rehabilitation. SETTING: This study was conducted at Veterans Administration Medical Center, San Diego.MethodsBetween 1998 and 2010, N=118 Veterans participated in a Commission on Accreditation of Rehabilitation Facilities (CARF)-accredited rehabilitation program after a new SCI. Pre-rehabilitation measures of impairment at the organ/body level, activity limitation at the person level and participation restriction at the societal level were used to predict Satisfaction with Life Scale (SWLS) scores upon discharge. RESULTS: Although overall mean SWLS admission and discharge scores were not significantly different (P>0.10), individual change in SWLS scores during rehabilitation was notable, ranging from a 17-point improvement to a 22-point decline across veterans (mean Δ=+1.18, s.d.=6.04). Veterans who exhibited less activity limitation (higher cognitive functioning, r=0.31, P<0.01) and less participation restriction (greater social integration, r=0.21, P<0.05; a trend toward greater economic sufficiency, r=0.16, P<0.10) at baseline had higher SWLS scores after rehabilitation. When these factors were entered together into a single regression model, only cognitive functioning remained statistically significant (P<0.05). CONCLUSION: Findings highlight potential targets for interventions, aiming to improve SWL post SCI among US veterans. In addition to directly targeting SWL with psychosocial interventions, results suggest that rehabilitation settings should continue and/or expand upon programs targeting cognitive functioning (activity limitation) and social integration (participation restriction). Nevertheless, additional research is warranted to identify the biopsychosocial factors most reliably associated with SWL and/or other aspects of quality of life.