Glycemic Variability and Fluctuations in Cognitive Status in Adults With Type 1 Diabetes (GluCog): Observational Study Using Ecological Momentary Assessment of Cognition
BackgroundIndividuals with type 1 diabetes represent a population with important vulnerabilities to dynamic physiological, behavioral, and psychological interactions, as well as cognitive processes. Ecological momentary assessment (EMA), a methodological approach used to stud...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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JMIR Publications
2023-01-01
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| Series: | JMIR Diabetes |
| Online Access: | https://diabetes.jmir.org/2023/1/e39750 |
| _version_ | 1797734596378361856 |
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| author | Luciana Mascarenhas Fonseca Roger W Strong Shifali Singh Jane D Bulger Michael Cleveland Elizabeth Grinspoon Kamille Janess Lanee Jung Kellee Miller Eliza Passell Kerry Ressler Martin John Sliwinski Alandra Verdejo Ruth S Weinstock Laura Germine Naomi S Chaytor |
| author_facet | Luciana Mascarenhas Fonseca Roger W Strong Shifali Singh Jane D Bulger Michael Cleveland Elizabeth Grinspoon Kamille Janess Lanee Jung Kellee Miller Eliza Passell Kerry Ressler Martin John Sliwinski Alandra Verdejo Ruth S Weinstock Laura Germine Naomi S Chaytor |
| author_sort | Luciana Mascarenhas Fonseca |
| collection | DOAJ |
| description |
BackgroundIndividuals with type 1 diabetes represent a population with important vulnerabilities to dynamic physiological, behavioral, and psychological interactions, as well as cognitive processes. Ecological momentary assessment (EMA), a methodological approach used to study intraindividual variation over time, has only recently been used to deliver cognitive assessments in daily life, and many methodological questions remain. The Glycemic Variability and Fluctuations in Cognitive Status in Adults with Type 1 Diabetes (GluCog) study uses EMA to deliver cognitive and self-report measures while simultaneously collecting passive interstitial glucose in adults with type 1 diabetes.
ObjectiveWe aimed to report the results of an EMA optimization pilot and how these data were used to refine the study design of the GluCog study. An optimization pilot was designed to determine whether low-frequency EMA (3 EMAs per day) over more days or high-frequency EMA (6 EMAs per day) for fewer days would result in a better EMA completion rate and capture more hypoglycemia episodes. The secondary aim was to reduce the number of cognitive EMA tasks from 6 to 3.
MethodsBaseline cognitive tasks and psychological questionnaires were completed by all the participants (N=20), followed by EMA delivery of brief cognitive and self-report measures for 15 days while wearing a blinded continuous glucose monitor. These data were coded for the presence of hypoglycemia (<70 mg/dL) within 60 minutes of each EMA. The participants were randomized into group A (n=10 for group A and B; starting with 3 EMAs per day for 10 days and then switching to 6 EMAs per day for an additional 5 days) or group B (N=10; starting with 6 EMAs per day for 5 days and then switching to 3 EMAs per day for an additional 10 days).
ResultsA paired samples 2-tailed t test found no significant difference in the completion rate between the 2 schedules (t17=1.16; P=.26; Cohen dz=0.27), with both schedules producing >80% EMA completion. However, more hypoglycemia episodes were captured during the schedule with the 3 EMAs per day than during the schedule with 6 EMAs per day.
ConclusionsThe results from this EMA optimization pilot guided key design decisions regarding the EMA frequency and study duration for the main GluCog study. The present report responds to the urgent need for systematic and detailed information on EMA study designs, particularly those using cognitive assessments coupled with physiological measures. Given the complexity of EMA studies, choosing the right instruments and assessment schedules is an important aspect of study design and subsequent data interpretation. |
| first_indexed | 2024-03-12T12:45:40Z |
| format | Article |
| id | doaj.art-a113f8430f6041a5899ecd483e892f16 |
| institution | Directory Open Access Journal |
| issn | 2371-4379 |
| language | English |
| last_indexed | 2024-03-12T12:45:40Z |
| publishDate | 2023-01-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | JMIR Diabetes |
| spelling | doaj.art-a113f8430f6041a5899ecd483e892f162023-08-28T23:23:28ZengJMIR PublicationsJMIR Diabetes2371-43792023-01-018e3975010.2196/39750Glycemic Variability and Fluctuations in Cognitive Status in Adults With Type 1 Diabetes (GluCog): Observational Study Using Ecological Momentary Assessment of CognitionLuciana Mascarenhas Fonsecahttps://orcid.org/0000-0002-2849-0545Roger W Stronghttps://orcid.org/0000-0002-6645-8116Shifali Singhhttps://orcid.org/0000-0003-1312-665XJane D Bulgerhttps://orcid.org/0000-0002-3585-4896Michael Clevelandhttps://orcid.org/0000-0002-7649-1323Elizabeth Grinspoonhttps://orcid.org/0000-0002-5608-8254Kamille Janesshttps://orcid.org/0000-0001-5771-4133Lanee Junghttps://orcid.org/0000-0003-3555-5287Kellee Millerhttps://orcid.org/0000-0002-5684-8284Eliza Passellhttps://orcid.org/0000-0003-3198-6071Kerry Resslerhttps://orcid.org/0000-0002-5158-1103Martin John Sliwinskihttps://orcid.org/0000-0002-9611-7558Alandra Verdejohttps://orcid.org/0000-0002-4378-7515Ruth S Weinstockhttps://orcid.org/0000-0001-5859-5666Laura Germinehttps://orcid.org/0000-0001-8690-8412Naomi S Chaytorhttps://orcid.org/0000-0001-8821-289X BackgroundIndividuals with type 1 diabetes represent a population with important vulnerabilities to dynamic physiological, behavioral, and psychological interactions, as well as cognitive processes. Ecological momentary assessment (EMA), a methodological approach used to study intraindividual variation over time, has only recently been used to deliver cognitive assessments in daily life, and many methodological questions remain. The Glycemic Variability and Fluctuations in Cognitive Status in Adults with Type 1 Diabetes (GluCog) study uses EMA to deliver cognitive and self-report measures while simultaneously collecting passive interstitial glucose in adults with type 1 diabetes. ObjectiveWe aimed to report the results of an EMA optimization pilot and how these data were used to refine the study design of the GluCog study. An optimization pilot was designed to determine whether low-frequency EMA (3 EMAs per day) over more days or high-frequency EMA (6 EMAs per day) for fewer days would result in a better EMA completion rate and capture more hypoglycemia episodes. The secondary aim was to reduce the number of cognitive EMA tasks from 6 to 3. MethodsBaseline cognitive tasks and psychological questionnaires were completed by all the participants (N=20), followed by EMA delivery of brief cognitive and self-report measures for 15 days while wearing a blinded continuous glucose monitor. These data were coded for the presence of hypoglycemia (<70 mg/dL) within 60 minutes of each EMA. The participants were randomized into group A (n=10 for group A and B; starting with 3 EMAs per day for 10 days and then switching to 6 EMAs per day for an additional 5 days) or group B (N=10; starting with 6 EMAs per day for 5 days and then switching to 3 EMAs per day for an additional 10 days). ResultsA paired samples 2-tailed t test found no significant difference in the completion rate between the 2 schedules (t17=1.16; P=.26; Cohen dz=0.27), with both schedules producing >80% EMA completion. However, more hypoglycemia episodes were captured during the schedule with the 3 EMAs per day than during the schedule with 6 EMAs per day. ConclusionsThe results from this EMA optimization pilot guided key design decisions regarding the EMA frequency and study duration for the main GluCog study. The present report responds to the urgent need for systematic and detailed information on EMA study designs, particularly those using cognitive assessments coupled with physiological measures. Given the complexity of EMA studies, choosing the right instruments and assessment schedules is an important aspect of study design and subsequent data interpretation.https://diabetes.jmir.org/2023/1/e39750 |
| spellingShingle | Luciana Mascarenhas Fonseca Roger W Strong Shifali Singh Jane D Bulger Michael Cleveland Elizabeth Grinspoon Kamille Janess Lanee Jung Kellee Miller Eliza Passell Kerry Ressler Martin John Sliwinski Alandra Verdejo Ruth S Weinstock Laura Germine Naomi S Chaytor Glycemic Variability and Fluctuations in Cognitive Status in Adults With Type 1 Diabetes (GluCog): Observational Study Using Ecological Momentary Assessment of Cognition JMIR Diabetes |
| title | Glycemic Variability and Fluctuations in Cognitive Status in Adults With Type 1 Diabetes (GluCog): Observational Study Using Ecological Momentary Assessment of Cognition |
| title_full | Glycemic Variability and Fluctuations in Cognitive Status in Adults With Type 1 Diabetes (GluCog): Observational Study Using Ecological Momentary Assessment of Cognition |
| title_fullStr | Glycemic Variability and Fluctuations in Cognitive Status in Adults With Type 1 Diabetes (GluCog): Observational Study Using Ecological Momentary Assessment of Cognition |
| title_full_unstemmed | Glycemic Variability and Fluctuations in Cognitive Status in Adults With Type 1 Diabetes (GluCog): Observational Study Using Ecological Momentary Assessment of Cognition |
| title_short | Glycemic Variability and Fluctuations in Cognitive Status in Adults With Type 1 Diabetes (GluCog): Observational Study Using Ecological Momentary Assessment of Cognition |
| title_sort | glycemic variability and fluctuations in cognitive status in adults with type 1 diabetes glucog observational study using ecological momentary assessment of cognition |
| url | https://diabetes.jmir.org/2023/1/e39750 |
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