Diabetes distress and glycaemic control in young adults with type 1 diabetes: Associations by use of insulin pumps and continuous glucose monitors

Aims We determined whether high diabetes distress (DD) in young adults with type 1 diabetes was associated with higher glycated haemoglobin (HbA1c ) levels and whether this association was similar among those who were and were not using diabetes devices (insulin pumps and/or continuous glucose monitors [CGMs]). Methods In 2017 an online survey was completed by 423 of 743 (57%) young adults (19-31 years) with type 1 diabetes receiving care at a specialty clinic in New York City. HbA1c level was the primary outcome measure, and high DD (Diabetes Distress Scale score ≥3) was the primary exposure. Associations were adjusted for sociodemographic covariates. Results Of the 419 respondents with complete DD data, 59% were female and 69% were non-Hispanic white. Both devices (pump and CGM) were used by 35%, either device by 42%, and neither device by 24%. The mean (SD) HbA1c was 64 (19) mmol/mol [8.0 (1.7) %], and 24% had high DD. The adjusted mean (95% confidence interval) HbA1c was 10 (6, 14) mmol/mol [0.9 (0.5, 1.2) %] greater in those with high DD than in those without it. This HbA1c difference associated with high DD was similar regardless of device use: 9 (3, 15) mmol/mol [0.8 (0.3, 1.4) %] greater among those using both devices; and 9 (-0.9, 18) mmol/mol [0.8 (-0.1, 1.7) %] greater among those using neither device. Conclusions High DD in young adults requires more attention because it is associated with higher HbA1c levels, even among those using insulin pumps and CGMs.