Autonomic nervous system dysregulation Associated with Diabetes Distress in T1D and T2D, reveals study
A new study published in the Diabetes Care journal revealed a significant link between symptoms of autonomic nervous system (ANS) dysregulation and diabetes-related emotional distress in adults living with both type 1 (T1D) and type 2 diabetes (T2D). This two-part investigation highlighted how internal physiological stress responses may be closely tied to the emotional challenges of managing diabetes.
The research included 556 adults with T1D and 299 with T2D. The participants completed online surveys assessing symptoms of ANS reactivity through the Body Perception Questionnaire (BPQ), alongside validated tools for measuring diabetes distress (the DDS-T1 for type 1 diabetes and DDS-17 for type 2) as well as general anxiety (GAD-7), depression (PHQ-8), and demographic information.
In Study 1, focusing on adults with T1D, participants had an average age of 45.1 years. The majority were female (73.2%) and White (95.3%). Self-reported average HbA1c levels were relatively well-controlled at 6.7%, and most participants (72.5%) used insulin pumps. The average duration of diabetes was over two decades (20.6 years). On the diabetes distress scale (DDS-T1), the mean score was 2.3, which was indicative of moderate emotional distress related to diabetes management.
ANS symptoms were measured in two main domains: supradiaphragmatic (related to functions like breathing and heart rate) and subdiaphragmatic (digestive and other lower-body systems). Average T scores were 48.9 and 50.6, respectively, slightly below or near the general population mean (T = 50).
In Study 2, which assessed adults with T2D, the average age was higher at 60.2 years. A slightly lower proportion of participants were female (58.7%), and 82.9% identified as White. The group reported slightly higher HbA1c levels at 7.0%, and diabetes duration averaged 15 years. Medication use varied, with 51.8% on oral medications alone and 39.9% combining oral and injectable therapies. Diabetes distress scores (DDS-17) also averaged 2.3, again reflecting moderate distress. BPQ T scores for this group were similar among the groups with 49.9 (supradiaphragmatic) and 52.0 (subdiaphragmatic).
After adjusting for anxiety, depression, and other relevant factors, this study found that higher diabetes distress scores significantly predicted greater ANS symptom severity across all domains in both groups (p ≤ 0.05). The participants with the highest levels of diabetes distress reported the highest BPQ scores, suggesting that psychological strain may be closely associated with disruptions in nervous system regulation. Overall, these findings illuminate the importance of addressing emotional well-being in diabetes care.
Source:
de Groot, M., Myers, B. A., Stump, T. E., Dana, D., Lewis, G., Kolacz, J., Baker, L., Fox, K. A., & Porges, S. W. (2025). Symptoms of autonomic nervous system dysregulation and diabetes distress in adults with type 1 and type 2 diabetes. Diabetes Care, 48(5), 781–789. https://doi.org/10.2337/dc24-2614