Ecological Momentary Assessment of Person-Reported Outcomes in Diabetes: Unlocking Insights with Continuous Glucose Monitoring and the Potential for Precision Medicine

Diabetes self-management is accompanied by time-varying emotional and motivational challenges that impact mental health. These day-to-day fluctuations can be assessed via ecological momentary assessment (EMA), that allows the repeated sampling of psychosocial variables in everyday life. The benefits of EMA over questionnaires mirror the benefits of continuous glucose monitoring (CGM) over HbA1c. We describe the insights generated by combining EMA and CGM and highlight its potential. Research shows that glucose levels can influence subsequent mood, stress, cognitive functioning, and symptom reporting, with nocturnal hypoglycemia and overnight glucose being particularly relevant. Studies demonstrated the importance of differentiating between subjective person-interpreted and objectively sensor-assessed glucose levels. N-of-1 analyses revealed relevant intraindividual differences in the association between glycemic and psychosocial parameters. Combining EMA and CGM can enhance our understanding of the dynamic relationship between glycemic and psychosocial variables, supporting precision medicine approaches for mental health in diabetes.