People with diabetes felt better after days when their blood sugar had more room to fluctuate, suggesting that tighter control may sometimes come at the expense of daily life.
New research involving people with type 1 and type 2 diabetes found that spending more time within the normal glucose range predicted better quality of life the following day. Surprisingly, greater glucose fluctuations were also associated with improved well-being, suggesting that overly strict control may impose restrictions that interfere with everyday activities.
The research will be presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD) in Milan, Italy (September 28 – October 2). It was led by Professor Dominic Ehrmann of FIDAM (Research Institute Diabetes Academy Mergentheim) in Bad Mergentheim, Germany.
Looking Beyond Glucose Targets
Preventing dangerously high or low blood sugar remains essential, but modern diabetes care also recognizes the mental effort required to make constant decisions about food, insulin, exercise, sleep, and daily routines. A treatment strategy that produces impressive numbers can still be difficult to sustain if it places too many limits on everyday life.
To explore that balance, the researchers examined whether glucose patterns recorded by continuous glucose monitoring (CGM) devices could predict how participants felt the following day. Unlike a single blood test, CGM tracks glucose around the clock and reveals how much time a person spends within, above, or below specific ranges.
The analysis was part of the PRO-MENTAL study, funded by the German Center for Diabetes Research (DZD). Participants rated their quality of life every day for 14 consecutive days using ecological momentary assessment (EMA), which captures experiences as they occur rather than asking people to recall them weeks or months later.
Tracking Daily Well-Being
Quality of life was measured with five statements adapted from the WHO-5 questionnaire:
- I have felt cheerful and in good spirits
- I have felt calm and relaxed
- I have felt active and vigorous
- I woke up feeling fresh and rested
- My daily life has been filled with things that interest me
Participants also recorded their sleep quality, perceived stress, mood, and energy each day using the same EMA approach. Energy was rated on a scale from 0 (not at all) to 10 (very much).
The researchers matched those responses with CGM data collected during the same 14-day period. They calculated time below the safe range (TBR: <70 mg/dl), time above the safe range (TAR: >180 mg/dl), time in the normal range (normoglycemia) (TING: 70-140 mg/dl), and overall glucose variability.
Comparing Glucose With The Following Day
Statistical models tested whether glucose readings, sleep, stress, mood, and energy on one day predicted quality of life the next day. A separate analysis examined whether those factors were connected to quality of life on the same day.
The calculations accounted for age, sex, diabetes type, and each participant’s previous quality of life score. This helped the researchers determine whether the observed relationships persisted beyond a person’s usual level of well-being.
The study included 400 people with diabetes. Of those participants, 72% had type 1 diabetes, 28% had type 2 diabetes, and 55% were female. Their median age was 47 years (range 32-63 years), and their average glycated hemoglobin level (HbA1c – a measure of blood sugar control) was 7.6%.
More Time In Range Predicted Better Days
People who spent more time within the normal glucose range on one day tended to report better quality of life the next day. Time spent above or below the safe range, however, was not significantly associated with next-day quality of life.
The more surprising result involved glucose variability. Participants also reported better quality of life after days when their glucose varied more than usual. Glucose measurements recorded on the same day did not show a significant relationship with that day’s quality of life.
Sleep and energy mattered as well. Better sleep during the previous night and feeling more energetic on the preceding day were both associated with improved quality of life, showing that glucose was only one part of the broader picture.
The Cost Of Pursuing Perfect Control
The authors said: “Days with higher time in the normal safe range for blood sugar were followed by days on which individuals with type 1 and type 2 diabetes reported better quality of life, underscoring the importance of optimal blood sugar control for well-being.
“Interestingly, higher-than-usual glucose variability was also associated with improved next-day quality of life. These findings may suggest 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, which may contribute to some people living with diabetes feeling unable to safely engage in certain activities.”
Meeting: Annual Meeting of the European Association for the Study of Diabetes (EASD)
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