203-OR: Characterizing Moment-to-Moment Fluctuations in Stress, Anxiety, and Blood Glucose Levels in Adolescents with Type 1 Diabetes

Objectives: It is now well documented that adolescents with T1D are at greater risk for elevated anxiety than young people without diabetes. In addition, higher levels of state anxiety are associated with higher haemoglobin A1c (HbA1c), less frequent blood glucose monitoring, and more poorly controlled diabetes. Anxiety is also predictive of poor glycaemic control as far as 12 months into the future. To better understand how stress and anxiety may be related to moment-to-moment fluctuations in blood glucose levels, we used a novel method of measuring changes in emotional state in real time, known as experience sampling methodology (ESM), in combination with continuous glucose monitoring (CGM) technology. Methods: ESM is an ambulatory research method whereby participants respond to questions sent via a smartphone ‘app’ at multiple times throughout the day. In this study, adolescents (n= 53) diagnosed with T1D (aged 12-18 years) responded to questions regarding their current emotional state 10 times a day, over a 10-day period. Results: Preliminary analysis, using multilevel regression modelling, explored the relationships between anxiety and measures of glycaemic control. The following measures of glycaemic control were examined: concurrent sensor glucose (SGL), mean sensor glucose in the previous 60 minutes, and standard deviation (SD) of sensor glucose in the previous 60 minutes. The results of the model indicated that a quadratic term for concurrent SGL (p < 0.001) and SD of sensor glucose (p = 0.005) were significant independent predictors of anxiety. The relationship between concurrent SGL and anxiety was U-shaped, with the vertex (minimum) of 7.8 mmol/L. Conclusions: These novel findings confirm that elevated anxiety is associated with sub-optimal blood glucose levels in the preceding hour. Further analysis of this data will explore this relationship in greater detail, including possible inter-individual variation in this pattern. Disclosure K. Bebbington: None. D. Rudaizky: None. G.J. Smith: None. A.M. Hunt: None. E.A. Davis: None. T. Jones: Research Support; Self; Dexcom, Inc., Medtronic MiniMed, Inc. Speaker's Bureau; Self; Eli Lilly and Company, Roche Diabetes Care. A. Lin: None.