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Psychosom Med. 2017 Sep;79(7):798-805. doi: 10.1097/PSY.0000000000000477.

Mean Levels and Variability in Affect, Diabetes Self-Care Behaviors, and Continuously Monitored Glucose: A Daily Study of Latinos With Type 2 Diabetes.

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From the Division of Behavioral Sciences and Community Health (Wagner, Bermudez-Millan), Department of Psychiatry (Wagner), UConn Schools of Medicine and Dental Medicine, Farmington, Connecticut; Department of Psychology (Armeli), Farleigh Dickinson University, Taeneck, New Jersey; Department of Community Medicine (Tennen), UConn School of Medicine, Farmington, Connecticut; Joslin Diabetes Center/Harvard Medical School (Wolpert), Boston, Massachusetts; and Department of Social and Behavioral Sciences (Pérez-Escamilla), Yale School of Public Health, New Haven, Connecticut.



This study investigated between- and within-person associations among mean levels and variability in affect, diabetes self-care behaviors, and continuously monitored glucose in Latinos with type 2 diabetes.


Fifty participants (M [SD] age = 57.8 [11.7] years, 74% women, mean [SD] glycosylated hemoglobin A1c = 8.3% [1.5%]) wore a "blinded" continuous glucose monitor for 7 days, and they responded to twice daily automated phone surveys regarding positive affect, negative affect, and self-care behaviors.


Higher mean levels of NA were associated with higher mean glucose (r = .30), greater percent hyperglycemia (r = .34) and greater percentage of out-of-range glucose (r = .34). Higher NA variability was also related to higher mean glucose (r = .34), greater percent of hyperglycemia (r = .44) and greater percentage of out-of-range glucose (r = .43). Higher positive affect variability was related to lower percentage of hypoglycemia (r = -.33). Higher mean levels of self-care behaviors were related to lower glucose variability (r = -.35). Finally, higher self-care behavior variability was related to greater percentage of hyperglycemia (r = .31) and greater percentage of out-of-range glucose (r = -.28). In multilevel regression models, within-person increases from mean levels of self-care were associated with lower mean levels of glucose (b = -7.4, 95% confidence interval [CI] = -12.8 to -1.9), lower percentage of hyperglycemia (b = -0.04, 95% CI = -0.07 to -0.01), and higher percentage of hypoglycemia (b = 0.02, 95% CI = 0.01 to 0.03) in the subsequent 10-hour period.


Near-to-real time sampling documented associations of glucose with affect and diabetes self-care that are not detectable with traditional measures.

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