@article{2a39deb6a068441091ef02abd387258c,
title = "Body Mass Index Effect on Differing Responses to Psychological Stress in Blood Glucose Dynamics in Patients With Type 1 Diabetes",
abstract = "Objective: The objective was to investigate the relationship of body mass index (BMI) to differing glycemic responses to psychological stress in patients with type 1 diabetes. Methods: Continuous blood glucose monitor (CGM) data were collected for 1 week from a total of 37 patients with BMI ranging from 21.5-39.4 kg/m2 (mean = 28.2 ± 4.9). Patients reported daily stress levels (5-point Likert-type scale, 0 = none, 4 = extreme), physical activity, carbohydrate intake, insulin boluses and basal rates. Daily reported carbohydrates, total insulin bolus, and average blood glucose (BG from CGM) were compared among patients based on their BMI levels on days with different stress levels. In addition, daily averages of a model-based “effectiveness index” (quantifying the combined impact of insulin and carbohydrate on glucose levels) were defined and compared across stress levels to capture meal and insulin independent glycemic changes. Results: Analyses showed that patient BMI likely moderated stress related glycemic changes. Linear mixed effect model results were significant for the stress-BMI interaction on both behavioral and behavior-independent glycemic changes. Across participants, under stress, an increase was observed in daily carbohydrate intake and effectiveness index at higher BMI. There was no significant interactive effect on daily insulin or average BG. Conclusion: Findings suggest that (1) stress has both behavioral and nonbehavioral glycemic effects on T1D patients and (2) the direction and magnitude of these effects are potentially influenced by level of stress and patient BMI. Possibly responsible for these observed effects are T1D/BMI related alterations in endocrine response.",
keywords = "body mass index, effectiveness index, glycemic variability, stress, type 1 diabetes",
author = "Basak Ozaslan and Patek, {Stephen D.} and Grabman, {Jesse H.} and Shepard, {Jaclyn A.} and Eyal Dassau and Breton, {Marc D.} and Kudva, {Yogish C.} and Brown, {Sue A.} and Ananda Basu and Pinsker, {Jordan E.} and Doyle, {Francis J.} and Linda Gonder-Frederick",
note = "Funding Information: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: SDP acknowledges equity interest in and active participation with TypeZero Technologies, Inc. SAB reports materials support managed by the University of Virginia from Roche Diagnostics Inc, Dexcom, Tandem Diabetes Care, and LifeScan and grant support from Animas and Medtronic. Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the National Institutes of Health Grant Numbers DP3DK094331, R01DK085628 to UCSB, DK85516 (Mayo) and Grant Number UL1 TR000135 from the National Center for Advancing Translational Science (NCATS) and the Urdang Family Foundation to Mayo Clinic. Product support was provided by Animas Corp (insulin pumps in-kind), Dexcom Inc (research discount on CGM supplies), and the Investigator-Initiated Study Program of LifeScan, Inc (glucometer test strips in-kind). Funding Information: We would like to show our gratitude to Boris Kovatchev, PhD (University of Virginia Center for Diabetes Technology) who provided insight and expertise during the course of this research, to Joe Clayton Ford, MS (University of Virginia, StatLab) for his knowledge and guidance on the statistical analyses conducted in this study, and to Chiara Fabris, PhD (University of Virginia Center for Diabetes Technology) for support and insightful discussions. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the National Institutes of Health Grant Numbers DP3DK094331, R01DK085628 to UCSB, DK85516 (Mayo) and Grant Number UL1 TR000135 from the National Center for Advancing Translational Science (NCATS) and the Urdang Family Foundation to Mayo Clinic. Product support was provided by Animas Corp (insulin pumps in-kind), Dexcom Inc (research discount on CGM supplies), and the Investigator-Initiated Study Program of LifeScan, Inc (glucometer test strips in-kind). Publisher Copyright: {\textcopyright} 2018, {\textcopyright} 2018 Diabetes Technology Society.",
year = "2018",
month = may,
day = "1",
doi = "10.1177/1932296818758103",
language = "English (US)",
volume = "12",
pages = "657--664",
journal = "Journal of Diabetes Science and Technology",
issn = "1932-2968",
publisher = "Diabetes Technology Society",
number = "3",
}