Keeping blood sugar too steady may come at a price

People with diabetes who try to keep their blood sugar within very tight limits may pay a price in their quality of life, according to a new study presented through the European Association for the Study of Diabetes.

The research, led by Professor Dominic Ehrmann of the Research Institute Diabetes Academy Mergentheim in Germany, followed 400 people with diabetes for 14 days.

How the study worked

Participants wore continuous glucose monitors, which track blood sugar around the clock, and answered short daily questions about how they felt, based on the World Health Organization's WHO-5 wellbeing questionnaire. Of the 400 people, 72 per cent had type 1 diabetes and 28 per cent type 2. Their average age was 47, 55 per cent were women and their average HbA1c, a measure of long-term blood sugar, was 7.6 per cent.

What the researchers found

Spending more time in the normal glucose range, between 70 and 140 mg/dl, on one day was significantly associated with better quality of life the next day. But, unexpectedly, higher-than-usual glucose variability was also associated with better wellbeing the following day. Better sleep was linked to feeling better, too, while glucose readings on the same day showed no link with how people felt that day.

The researchers suggested that "individuals experience lower quality of life when attempting to minimize glucose fluctuations too strictly, potentially due to the associated burden or restrictions in daily life."

What it means

Keeping blood sugar under control remains essential to reducing the long-term risks of diabetes, including damage to the eyes, kidneys, nerves and heart. The study does not suggest otherwise. What it adds is a reminder that living with diabetes involves constant decisions about food, activity and medication, and that striving for perfect numbers can itself be a heavy load.

The authors say the findings support care that pays attention to wellbeing as well as blood sugar targets. The work was funded by the German Center for Diabetes Research.