Symptoms of Autonomic Nervous System Dysregulation and Diabetes Distress in Adults With Type 1 and Type 2 Diabetes

Abstract

OBJECTIVE To test the association of autonomic nervous system (ANS) dysregulation symptoms and diabetes distress (DD) in adults with type 1 diabetes (T1D; study 1) and type 2 diabetes (T2D; study 2). RESEARCH DESIGN AND METHODS A total of 556 adults with T1D and 299 with T2D completed the Body Perception Questionnaire (BPQ) to assess ANS reactivity symptoms, diabetes distress (via Diabetes Distress Scale T1 [DDS-T1], and DDS-17), anxiety (via General Anxiety Disorder 7 [GAD-7]) scale, depression (via Patient Health Questionnaire-8 [PHQ-8]), and demographic variables via internet surveys. RESULTS In study 1, participants’ mean age was 45.1 (SD 15.7) years and most were female (73.2%) and White (95.3%). The mean self-reported A1c was 6.7% (SD = 1.0%); mean duration of T1D diagnosis 20.6 (SD 14.7) years; and 72.5% of participants reported using an insulin pump. The mean DDS-T1 score was 2.3 (SD 0.8; moderate severity). The BPQ mean T score was 48.9 (SD 8.4) for supradiaphragmatic and 50.6 (SD 8.9) for subdiaphragmatic reactivity subscales. In study 2, participants’ mean age was 60.2 (SD 13.6) years, 58.7% were female, and 82.9% were White. The mean self-reported A1c was 7.0% (SD 1.2%), and 51.8% of participants were treated with oral hypoglycemic agents and 39.9% used oral and injectable medications. The mean duration of T2D diagnosis was 15.0 (SD 10.0) years. The mean DDS-17 score was 2.3 (SD 1.0; moderate severity) and BPQ mean T score was 49.9 (SD 9.4) for supradiaphragmatic and 52.0 (SD 8.8) for subdiaphragmatic reactivity subscales. Controlling for covariates, severity of DDS-T1/DDS-17 significantly predicted elevations in ANS symptom T scores on all subscales (P ≤ 0.05 for all), with “high” DDS having the highest BPQ scores. CONCLUSIONS These findings demonstrate a relationship between ANS reactivity and DDS in T1D and T2D samples.