Function and Emotion in Everyday Life with Type 1 Diabetes (FEEL-T1D)

Illness intrusiveness is a psychological process reflecting the perceived impact of illness-related disruptions on daily life in chronic conditions. Type 1 diabetes (T1D) disrupts daily activities through symptoms, self-care demands, and device use, yet little is known about how these disruptions shape psychosocial well-being. This study examined activity disruptions in adults with T1D using ecological momentary assessment (EMA) and tested whether illness intrusiveness mediates the relationship between activity disruptions and life satisfaction. A total of 196 adults with T1D completed 14 days of momentary activity disruption assessments and follow-up surveys assessing illness intrusiveness and life satisfaction. On average, participants reported disruptions in 11% of momentary daily activities, with notable variation across activity types, racial/ethnic groups, and treatment regimens. Activity disruption significantly predicted greater illness intrusiveness (β = 0.33, p < 0.001), which in turn predicted lower life satisfaction (β = -0.51, p < 0.001). Mediation analysis revealed that illness intrusiveness fully mediated the relationship when adjusted for income. Subtype analyses showed that device-related (indirect effect: β = -0.12, p < 0.001) and symptom-related disruptions (indirect effect: β = -0.12, p = 0.01) were fully mediated, whereas self-care disruptions were not associated with life satisfaction. Findings highlight the value of capturing real-time activity disruptions and suggest that illness intrusiveness may be a key explanatory mechanism linking activity disruption and psychosocial outcomes. Device burden and socioeconomic context emerged as factors shaping these relationships.

Keywords. activity disruption, illness intrusiveness, life satisfaction, type 1 diabetes

Background. Despite extensive research on the role of self-efficacy in behavioral performance across various domains, its specific influence on self-management behaviors in type 1 diabetes (T1D) remains unclear. While studies find inconsistent evidence on whether self-efficacy actively drives future behaviors or is instead shaped by prior performance, research directly examining these temporal relationships in T1D is limited.

Purpose. This study aims to examine the within-person, bidirectional, temporal relationships among self-efficacy, diabetes distress, self-management behavior, and glycemic regulation in T1D using intensive longitudinal data.

Methods. The current analyses used data from the Function and Emotion in Everyday Life with Type 1 Diabetes study (N = 173). Participants wore a blinded continuous glucose monitor (CGM) for 14 days and completed 5-6 smartphone-based surveys daily. Data were analyzed using dynamic structural equation modeling.

Results. Diabetes self-efficacy, distress, and self-management were significantly related within-person. Morning self-efficacy predicted lower diabetes distress and better management, both of which improved CGM outcomes. Lagged analyses revealed that prior-day self-efficacy, distress, and self-management predicted next-morning self-efficacy, but prior-day glucose did not. Feedback from personal use of unblinded CGM did not influence these relationships.

Conclusions. Findings support self-efficacy as both an influence on future T1D self-management behavior change and an outcome of prior emotional states and self-management performance. Results suggest that diabetes self-efficacy predicts short-term glycemic regulation primarily through its associations with changes in diabetes distress and self-management.

Keywords. type 1 diabetes, ecological momentary assessment, self-efficacy, diabetes distress, diabetes self-management, glycemic regulation

Objective. In an observational study, we paired ecological momentary assessment (EMA) and continuous glucose monitoring (CGM) to examine lagged effects of glycemic regulation on diabetes-related distress (DD), and vice versa, among adults with type 1 diabetes (T1D).

Research Design and Methods. Participants (N = 182; median ± SD age 40 ± 14 years; 54% women; 41% Latino; 29% White and 15% Black) wore a blinded CGM device for 14 days and completed five to six EMA surveys per day. We tested expected associations between momentary DD ratings and relevant patient-reported outcomes on validated questionnaires. Using multilevel cross-lagged modeling, we evaluated within-person lagged effects of CGM metrics (mean glucose mean; percentage of time in range [TIR; i.e., 70–180 mg/dL] and percentages of time 181–250, >250, and <70 mg/dL; and coefficient of variation [CV]) over 3-h periods on DD rated 0–100 at the end of that interval and 3 h later. We also examined lagged effects of DD on subsequent CGM metrics.

Results. Momentary DD ratings were significantly associated with results of questionnaires for DD, well-being, functional and mental health, and quality of life. Higher mean glucose, less TIR, greater percentage of time 181–250 and >250 mg/dL, and higher CV over 3 h each predicted greater DD at the end of that interval; higher 3-h mean glucose also predicted more DD 3 h later (P < 0.05). Greater DD unexpectedly predicted a lower percentage of time in hypoglycemia over the next 3 h (P < 0.05) but predicted no other CGM metrics.

Conclusions. Findings support the validity of EMA of DD in adults with T1D and suggest glucose dysregulation is linked to subsequent increased DD over the short term, not vice versa. These findings have implications for interventions targeting DD.

Associations between various forms of activity engagement (e.g. work, leisure) and the experience of stress in workers have been widely documented. The mechanisms underlying these effects, however, are not fully understood. Our goal was to investigate if perceived whole day workload accounted for the relationships between daily frequencies of activities (i.e. work hours and leisure/rest) and daily stress. We analysed data from 56 workers with type 1 diabetes (T1D) who completed approximately two weeks of intensive longitudinal assessments. Daily whole day workload was measured with an adapted version of the National Aeronautics and Space Administration Task Load Index (NASA-TLX). A variety of occupations were reported, including lawyer, housekeeper and teacher. In multilevel path analyses, day-to-day changes in whole day workload mediated 67% (p < .001), 61% (p < .001), 38% (p < .001), and 55% (p < .001) of the within-person relationships between stress and work hours, rest frequency, active leisure frequency, and day of week, respectively. Our results provided evidence that whole day workload perception may contribute to the processes linking daily activities with daily stress in workers with T1D. Perceived whole day workload may deserve greater attention as a possible stress intervention target, ones that perhaps ergonomists would be especially suited to address.

Keywords. Workload, stress, rest, work hours, type 1 diabetes

Workload experienced over the whole day, not just work periods, may impact worker cognitive performance. We hypothesized that experiencing greater than typical whole day workload would be associated with lower visual processing speed and lower sustained attention ability, on the next day. To test this, we used dynamic structural equation modeling to analyze data from 56 workers with type 1 diabetes. For a two-week period, on smartphones they answered questions about whole day workload at the end of each day, and completed cognitive tests 5 or 6 times throughout each day. Repeated smartphone cognitive tests were used, instead of traditional one- time cognitive assessment in the laboratory, to increase the ecological validity of the cognitive tests. Examples of reported occupations in our sample included housekeeper, teacher, physician, and cashier. On workdays, the mean number of work hours reported was 6.58 (SD 3.5). At the within-person level, greater whole day workload predicted decreased mean processing speed the next day (standardized estimate=-0.10, 95% CI -0.18 to -0.01) using a random intercept model; the relationship was not significant and only demonstrated a tendency toward the expected effect (standardized estimate= -0.07, 95% CI -0.15 to 0.01) in a model with a random intercept and a random regression slope. Whole day workload was not found to be associated with next-day mean sustained attention ability. Study results suggested that just one day of greater than average workload could impact next day processing speed, but future studies with larger sample sizes are needed to corroborate this finding.

Keywords. Whole day workload; Sustained attention; Processing speed; Cognitive performance; Type 1 diabetes

Relationships between activity engagement and health related quality of life (HRQOL) can differ based on the level of analyses. For instance, greater exercise on average may be linked with lower fatigue across individuals (between-person level), whereas the momentary experience of exercise may be associated with increased fatigue within an individual (within-person level). Disentangling the between- and within-person associations between everyday activities and HRQOL outcomes may provide insights for personalized lifestyle-oriented health promotion efforts for individuals with chronic conditions. The purpose of this paper was to examine the between- and within-person relationships between activity engagement and HRQOL relevant measures in a sample of 92 workers with type 1 diabetes (T1D), from whom we collected ecological momentary assessment (EMA) data 5–6 times daily over 14 days. At each EMA prompt, information was collected on the activity participants just engaged in, and HRQOL relevant metrics (e.g. mental health, blood glucose, fatigue, functioning). Momentary reports of “caring for others”, and more frequently “caring for others”, were both associated with decreased HRQOL. Reporting napping 10% or more of the time during a person’s waking hours, but not the momentary experience of napping, was associated with decreased HRQOL. Momentary reports of sleeping were associated with low activity satisfaction relative to other activities, but higher activity importance. Study results provided a quantitative representation of the lived experience of T1D covering multiple types of activity engagement, which potentially has health promotion implications for workers with T1D.

Keywords. Ecological momentary assessment; Health promotion; Human activities; Type 1 diabetes; Workers

Importance. Although occupational balance (OB) is a construct of importance to occupational therapy, existing OB assessments have not been validated in clinical populations.

Objective. To examine the validity and reliability of the 11-item version of the Occupational Balance Questionnaire (OBQ11) in U.S. adults with Type 1 diabetes.

Design. Data were analyzed from adults with Type 1 diabetes enrolled in a larger longitudinal study examining the relationships among blood glucose, emotion, and functioning. Dimensionality of the OBQ11 was assessed with item response theory (IRT); convergent validity was tested by examining whether associations between the OBQ11 and other constructs were consistent with a priori hypotheses.

Setting. Three outpatient clinical sites in the United States.

Participants. Data from 208 U.S. adults with Type 1 diabetes were included in the analyses (42% Latino, 29% White, 14% African American, 7% multiethnic, and 8% other).

Outcomes and Measures. Assessments administered include the OBQ11, Patient Health Questionnaire (depression), and Diabetes Self-Management Questionnaire.

Results. Overall, results from IRT models and correlational tests supported the reliability and validity of the OBQ11. For instance, higher scores on the OBQ11 were significantly associated with better self-ratings of diabetes management behaviors (r = .28, p < .001), lower depression symptoms (r = −.53, p < .001), and greater positive affect (r = .32, p < .001). A single-factor generalized partial credit model fit the OBQ11 acceptably well, supporting its unidimensionality.

Conclusions and Relevance. The OBQ11 may be a reliable and valid measure of OB appropriate for use in clinical populations such as adults with diabetes.

Keywords. adult, blood glucose, depressive disorders, diabetes mellitus, diabetes mellitus, type 1, diabetes mellitus, type 2, health, self-management, chronic disease, personal satisfaction

Background. While short-term blood glucose (BG) levels and variability are thought to underlie diminished function and emotional well-being in people with T1D, these relationships are poorly understood. The Function and Emotion in Everyday Life with T1D (FEEL-T1D) study focuses on investigating these short-term dynamic relationships among BG, function, and emotional well-being in adults with T1D.

Objective. To present the FEEL-T1D study design, methods, and study progress to date, including adaptations necessitated by the COVID-19 pandemic to implement the study fully remotely.

Methods. The FEEL-T1D study will recruit 200 adults 18-75 years old with T1D. Data collection includes a comprehensive survey battery, along with 14 days of intensive longitudinal data using blinded continuous glucose monitoring (CGM), ecological momentary assessments (EMA), ambulatory cognitive tasks, and accelerometers. All study procedures are conducted remotely, through mailing study equipment and using videoconferencing for study visits.

Results. To date, after 12 months of recruitment, 124 participants have enrolled in the FEEL-T1D study. Over 80% have provided concurrent CGM, EMA, and accelerometer data for at least 10 of the 14 days of data collection, and nearly 90% of EMA surveys have been completed, with minimal missing data.

Conclusions. Thus far, our reconfiguration of the FEEL-T1D protocol to be implemented remotely during the COVID-19 pandemic has been a success. The FEEL-T1D study will elucidate the dynamic relationships between blood glucose, emotional well-being, cognitive function and participation in daily activities. In doing so, it will pave the way for innovative just-in-time interventions and produce actionable insights to facilitate tailoring of diabetes treatment to optimize function and well-being among individuals with T1D.