Mind–glucose control interplay in type 1 diabetes: management of exam-related stress using the MiniMed™ 780G insulin pump among high school students

Abstract

Academic stress can significantly impact glycemic outcome and psychological well-being in adolescents with type 1diabetes (T1D). To evaluate the role of MiniMed™ 780G insulin pump in managing exam-induced glycemic deterioration among high school students with T1D. This prospective study included 53 adolescents with T1D using MiniMed™ 780G insulin pump. Participants were monitored during routine academic and exam periods. Psychological stress was measured using the Perceived Stress Scale (PSS-10), Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HAM-D). Serum cortisol level was assessed and continuous glucose monitoring (CGM) data were monitored. Paired t-test and Wilcoxon test were used for parametric and non-parametric data, respectively to identify changes in study variables between study periods. A p value < 0.05 was considered statistically significant. Although PSS-10, HAM-A and HAM-D scores as well as serum cortisol level (15.7 ± 4.6 versus 8.6 ± 3.1 µg/dL) were elevated in high school students with T1D during exam period compared with baseline values (p < 0.001); however, no significant change was found as regards mean sensor glucose (153.23 ± 14.1 versus 147.51 ± 13.7 mg/dL; p = 0.561), coefficient of variation (35.11 ± 8.0 versus 32.81 ± 8.2%; p = 0.167), time in range (TIR) (75.10 ± 8.8 versus 78.20 ± 9.0%; p = 0.086) and time in tight range (58.50 ± 7.0 versus 60.10 ± 7.5%; p = 0.311) which corresponds with the significant increase in auto basal and auto correction insulin delivery of MiniMed™ 780G (p < 0.001). The automated adaptive algorithm of the MiniMed™ 780G system mitigated exams-related stress hyperglycemia, reducing glycemic variability and successfully maintaining the recommended glycemic outcomes with a TIR greater than 70% throughout the exam period.