Perceived glucose levels matter more than CGM‑based data in predicting diabetes distress in type 1 or type 2 diabetes: a precision mental health approach usingn‑of‑1 analyses – published online 30/07/2024

Dominic Ehrmann, Norbert Hermanns, Andreas Schmitt, Laura Klinker, Thomas Haak, Bernhard Kulzer

Diabetes distress is one of the most frequently identified mental health issues in people with type 1 or type 2 diabetes, but little is known about the role of glycaemic management and whether subjective perceptions of glucose levels or objective glycaemic parameters are more important. In this issue, Ehrmann and Hermanns et al (https://doi.org/10.1007/s00125-024-06239-9) analyse whether diabetes distress stems more from people’s interpretation of their glucose levels or from continuous glucose monitoring (CGM) data itself. Overall, in people with type 1 or type 2 diabetes, subjective perceptions of glucose levels were stronger drivers of diabetes distress than actual CGM readings. In n-of-1 analyses, the extent to which perceptions and actual CGM readings drove distress was determined for each individual. The authors show that psychosocial well-being and glucose levels at 3 months’ follow-up differed depending on how strongly perceived glucose levels or actual CGM metrics contributed to diabetes distress. They highlight that this demonstrates the need to understand where diabetes distress comes from, as it may affect outcomes differently. The authors conclude that differentiating between the emotional impacts of perceived vs actual glucose levels would allow for more personalised therapy by selecting the most appropriate intervention strategy for reducing diabetes distress, paving the way for precision mental health in diabetes.