Time In Range: Mental Well-Being
The amount of time people with diabetes spend in the ideal blood glucose range has a big impact on their daily lives, but only a third feel that their current diabetes therapy is "very successful" at keeping their blood glucose between 70 and 180 mg/dl throughout the day. This unmet need was one of the key findings about patient-reported outcomes in diabetes that we presented to the FDA at its recent "Outcomes Beyond A1c" workshop (1).
More "time in range" also seems linked to better mental and emotional health. When asked what would be most likely to put them in a positive frame of mind about their diabetes and general health, adults with type 1 diabetes and type 2 diabetes on insulin were most likely to select "blood glucose numbers are on-target all day".
Furthermore, time spent in an ideal blood glucose range appears to be correlated with mental well-being. We asked 3,500 people with type 1 and 2 diabetes to estimate the share of their day spent in the ideal blood glucose range (70-180 mg/dl), and used an established research tool (2) to gauge their psychological functioning, happiness, and life satisfaction. We found that people who spend more time in range on a typical day have higher levels of mental well-being, on average, than those who spend less time with their blood glucose in range. As time spent in range increases, the share of respondents with "low" mental well-being drops significantly and the share with "high" mental well-being rises significantly (3). Unfortunately, less than half of people with diabetes estimate that they spend more than 75% of their time with their blood glucose in the ideal range.
Time in range is an important outcome for people with type 1 and type 2 diabetes, not only because it measures daily fluctuations in blood glucose levels, but also because it may impact mental well-being more generally. We are continuing to investigate the relationship between time in range and mental well-being; if you want to know more, have an opinion about this topic, or have a suggestion for research, let us know!
Note: Data weighted to reflect CDC-reported incidence of diabetes therapy groups: insulin only, insulin plus orals, orals only.
1. Click here for coverage of the FDA workshop on "Outcomes Beyond A1c" in the online diabetes publication diaTribe.
2. The Warwick-Edinburgh Mental Well-being Scale was funded by the Scottish Executive National Programme for improving mental health and well-being, commissioned by NHS Health Scotland, developed by the University of Warwick and the University of Edinburgh, and is jointly owned by NHS Health Scotland, the University of Warwick and the University of Edinburgh. Used by permission.
3. Mental well-being scores were categorized based on their standard deviation from the mean score for all respondents. "Low" mental well-being was defined as scoring more than one standard deviation below the mean, "average" mental well-being as scoring within one standard deviation of the mean, and "high" mental well-being as scoring more than one standard deviation above the mean.
If you want to know more, have an opinion about this topic, or have a suggestion for research, let us know!