Association between glycemic control in different emotional conditions and adherence to carbohydrate counting in people with type 1 diabetes during the COVID-19 pandemic in Brazil

Viana, Vandemberg Ramos; Carvalha, Manuela Maria de Lima; Kikuchi, Jeane Lorena Dias; Felício, Karem Miléo; Gomes, Daniela Lopes

doi:10.1590/1678-9865202336e220247

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ORIGINAL | Clinical Nutrition • Rev Nutr 36 • 2023 • https://doi.org/10.1590/1678-9865202336e220247 copy

Association between glycemic control in different emotional conditions and adherence to carbohydrate counting in people with type 1 diabetes during the COVID-19 pandemic in Brazil

Associação entre controle glicêmico em diferentes condições emocionais e adesão à contagem de carboidratos em pessoas com diabetes tipo 1 durante a pandemia de COVID-19 no Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

Evaluate the association between glycemic control in different emotional perceptions and the adherence to carbohydrate counting by adults with type 1 diabetes during the COVID-19 pandemic in Brazil.

Methods

This cross-sectional, descriptive, and analytical study was approved by the Research Ethics Committee (Opinion nº 4,147,663) and conducted in July 2020 using a Google Forms^® form. Socioeconomic and demographic data were collected; glycemic monitoring according to the individuals’ emotions at the time of measurement (happy, motivated, or hopeful; stressed or anxious; sad, distressed, or with depressive symptoms); data on adherence to carbohydrate counting and social distancing. Pearson’s Chi-Square test was applied with adjusted residual analysis (p<0.05).

Results

Approximately 64.62% of the 472 participants, had hyperglycemia when stressed/anxious, and 52.97% when they felt sad/distressed/depressive (p<0.000). Associations were observed between having normoglycemia in any emotional situation and performing the carbohydrate counting (p<0.000); perceiving oneself as happy/motivated/hopeful and having hyperglycemia, and not measuring blood glucose was associated with not having the carbohydrate counting (p<0.000); being stressed or anxious was associated with not measuring blood glucose and not having the carbohydrate counting (p<0.000).

Conclusion

The need for multidisciplinary care to enhance mental health and adherence to treatment for people with type 1 diabetes is highlighted.

Keywords
Behavior; Diabetes Mellitus, type 1; Mental health; Social isolation

Variables		Mean	Standard deviation	p-value^* * Chi-square.
Age		30.24	9.74	-
Sex
	Female	406	86.02	<0.000
	Male	66	13.98	<0.000
Household income (MW)
	<1	19	4.03	<0.000
	1 – 2	134	28.39
	3 - ≤5	153	32.42
	>5 - ≤10	103	21.82
	>10 - ≤20	46	9.75
	>20	17	3.60
Education
	Without higher education	112	23.73	<0.000
	With higher education	360	76.27	<0.000
Macro-region
	North	33	6.99	<0.000
	Northeast	97	20.55
	Midwest	37	7.84
	Southeast	222	47.03
	South	83	17.58
Distancing type
	Total	89	18.86	<0.000
	Partial	310	65.68
	Did not perform because they needed to work	67	14.19
	Did not perform because they disagreed	1	0.21
	Were distant for family reasons. despite not agreeing	5	1.06

Variables			n	%	p-value^* * Chi-square.
Technology used to monitor blood glucose
		Glucometer	344	72.88	<0.000
		Flash glycemic monitoring system	18	3.81
		Flash glycemic monitoring and glucometer system	106	22.46
		Did not perform monitoring	4	0.85
Blood glucose and emotions
	When happy, motivated, or hopeful
		Hypoglycemia	16	3.39	<0.000
		Normoglycemia	333	70.55
		Hyperglycemia	82	17.37
		Did not have measured	31	6.57
		Did not know how to inform, as they did not have the inputs	10	2.12
	When stressed or anxious
		Hypoglycemia	35	7.42	<0.000
		Normoglycemia	97	20.55
		Hyperglycemia	305	64.62
		Did not have measured	25	5.30
		Did not know how to inform, as they did not have the inputs	10	2.12
	When sad, distressed, or with depressive symptoms
		Hypoglycemia	46	9.75	<0.000
		Normoglycemia	128	27.12
		Hyperglycemia	250	52.97
		Did not have measured	39	8.26
		Did not know how to inform as they did not have the inputs	9	1.91

Variables		Carbohydrate Counting				p-value^* * Chi-square. Residual analysis:
		Did not perform		Perform
		n	%	n	%
When happy, motivated, or hopeful
	Hypoglycemia	7	1.48	9	1.91	<0.000
	Normoglycemia	93	19.70^(-) (-) Negative significant association.	240	50.85⁽⁺⁾ (+) Significant association;
	Hyperglycemia	46	9.75⁽⁺⁾ (+) Significant association;	36	7.63^(-) (-) Negative significant association.
	Did not have measured	21	4.45⁽⁺⁾ (+) Significant association;	10	2.12^(-) (-) Negative significant association.
	Did not know how to inform, as they did not have the inputs	8	1.69⁽⁺⁾ (+) Significant association;	2	0.42^(-) (-) Negative significant association.
When stressed or anxious
	Hypoglycemia	16	3.39	19	4.03	<0.000
	Normoglycemia	24	5.08^(-) (-) Negative significant association.	73	15.47⁽⁺⁾ (+) Significant association;
	Hyperglycemia	112	23.73	193	40.89
	Did not have measured	15	3.18⁽⁺⁾ (+) Significant association;	10	2.12^(-) (-) Negative significant association.
	Did not know how to inform, as they did not have the inputs	8	1.69⁽⁺⁾ (+) Significant association;	2	0.42^(-) (-) Negative significant association.
When sad, distressed, or with depressive symptoms
	Hypoglycemia	15	3.18	31	6.57	<0.000
	Normoglycemia	30	6.36^(-) (-) Negative significant association.	98	20.76⁽⁺⁾ (+) Significant association;
	Hyperglycemia	101	21.40	149	31.57
	Did not have measured	22	4.66	17	3.60
	Did not know how to inform, as they did not have the inputs	7	1.48⁽⁺⁾ (+) Significant association;	2	0.42^(-) (-) Negative significant association.

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Kênia Mara Baiocchi