{ "abstract": "Stress and diabetes distress impact glycemic control, self-care, and health outcomes in people living with diabetes, but current diabetes technologies lack easy-to-use, non-invasive methods to detect these states. The objective was to identify vocal features associated with stress and diabetes distress in people living with diabetes. Thus, we analyzed data from 679 adults with diabetes (381 women, 298 men), recruited via the global vocal biomarker screening platform Colive Voice. Participants recorded a standardized 30-second text. Vocal features were extracted using DisVoice across phonation, prosody, articulation, and phonological domains. Associations between vocal features and stress (self-reported, scale: 0–4) and diabetes distress (Problem Areas in Diabetes (PAID) questionnaire; categories: PAID<20, 20 ≤ PAID<40, 40 ≤ PAID<60, PAID≥60) were analyzed separately for men and women. Multivariate ordinal logistic regression models were adjusted for age, language, diabetes type, and HbA1c, with False Discovery Rate correction.In women, results suggest that stress was associated with 25 voice features across all domains, while distress was linked to one articulatory feature, suggesting broader effects of stress. In men, both stress (25 features) and distress (18 features) affected multiple domains, but with distinct acoustic patterns. No voice features were shared between stress and distress. These patterns were consistent across age, diabetes type, and language.To conclude, voice changes reflect stress and diabetes distress in people with diabetes, each characterized by distinct acoustic features and additional sex-specific signatures. These findings highlight the potential of vocal biomarkers to differentiate and monitor these emotional states, supporting more timely and personalized interventions to improve diabetes outcomes. Author summary: Stress and diabetes distress are common in people living with diabetes and can worsen blood sugar control and overall health. Currently, detecting these emotional states relies on questionnaires that are completed only at specific clinical visits, making it difficult to capture how they impact diabetes management. In this study, we explored whether voice recordings collected via smartphone could reflect stress and diabetes distress in adults with diabetes. We analyzed speech recordings from 679 participants and identified acoustic features of the voice that were statistically associated with each emotional state. We found that stress affected a broader range of vocal characteristics than diabetes distress, and that the two outcomes produced distinct vocal patterns with no overlapping features. We also found that these patterns differed between men and women, suggesting that vocal signatures of stress and distress in diabetes are sex-specific.", "abstract_shown": true, "affiliations": [ "Université Grenoble Alpes, Fonds de Dotation Clinatec, Grenoble, France", "Deep Digital Phenotyping Research Unit, Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg", "University of Luxembourg, Esch-sur-Alzette, Luxembourg", "Urban Development and Mobility, Luxembourg Institute of Socio-Economic Research, Porte des Sciences, Maison des Sciences Humaines, Esch sur Alzette/Belval, Luxembourg", "Université Grenoble Alpes, CEA-Leti, Grenoble, France", "Université Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble, France" ], "article_type": "Research Article", "arxiv": null, "author_total": 10, "authors": [ { "affs": [ 0 ], "name": "Charline Bour" }, { "affs": [ 1 ], "name": "Abir Elbéji" }, { "affs": [ 2 ], "name": "Dulce Canha" }, { "affs": [ 3 ], "name": "Noémie Topalian" }, { "affs": [ 4 ], "name": "Hanin Ayadi" }, { "affs": [ 5 ], "name": "Christelle Godin" }, { "name": "Claire Guyon-Gardeux" }, { "name": "Pierre-Yves Benhamou" }, { "name": "Malvina Billères" }, { "name": "Guy Fagherazzi" } ], "bibtex": "https://research.draconitic.com/paper/bfc1zftvpzgp8.bib", "cited_by": 1, "doi": "10.1371/journal.pdig.0001689", "fulltext_url": "https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0001689", "id": "bfc1zftvpzgp8", "issns": [ "2767-3170" ], "landing_url": "https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0001689", "language": null, "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "journal", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "3205|Emotion and Mood Recognition" ], [ "plos", "/Biology and life sciences/Bioacoustics" ], [ "plos", "/Biology and life sciences/Neuroscience/Cognitive science/Cognitive psychology/Perception/Sensory perception/Hearing/Pitch perception" ], [ "plos", "/Biology and life sciences/Neuroscience/Sensory perception/Hearing/Pitch perception" ], [ "plos", "/Biology and life sciences/Psychology/Cognitive psychology/Perception/Sensory perception/Hearing/Pitch perception" ], [ "plos", "/Biology and life sciences/Psychology/Emotions" ], [ "plos", "/Biology and life sciences/Psychology/Psychological stress" ], [ "plos", "/Medicine and health sciences/Endocrinology/Endocrine disorders/Diabetes mellitus" ], [ "plos", "/Medicine and health sciences/Medical conditions/Metabolic disorders/Diabetes mellitus" ], [ "plos", "/Medicine and health sciences/Mental health and psychiatry/Psychological stress" ], [ "plos", "/Physical sciences/Physics/Acoustics/Bioacoustics" ], [ "plos", "/Social sciences/Linguistics/Grammar/Phonology" ], [ "plos", "/Social sciences/Linguistics/Phonetics/Vowels" ], [ "plos", "/Social sciences/Linguistics/Speech" ], [ "plos", "/Social sciences/Psychology/Cognitive psychology/Perception/Sensory perception/Hearing/Pitch perception" ], [ "plos", "/Social sciences/Psychology/Emotions" ], [ "plos", "/Social sciences/Psychology/Psychological stress" ] ], "openalex": "W7204814398", "pdf_url": "https://journals.plos.org/digitalhealth/article/file?id=10.1371/journal.pdig.0001689&type=printable", "pmcid": null, "pmid": null, "published": "2026-08-31", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/bfc1zftvpzgp8.ris", "sources": [ { "first_seen": "2026-10-30T12:18:02Z", "native_id": "10.1371/journal.pdig.0001689", "source": "plos", "url": "https://journals.plos.org/digitalhealth/article?id=10.1371/journal.pdig.0001689" } ], "subjects": [ { "field": "biology", "origin": "plos:neuroscience", "subfield": "neuroscience" }, { "field": "medicine", "origin": "plos:endocrinology", "subfield": "endocrinology-metabolism" }, { "field": "medicine", "origin": "plos:mental health and psychiatry", "subfield": "psychiatry" } ], "title": "Voice changes associated with stress and distress in people living with diabetes: Results from the Colive Voice study", "title_text": "Voice changes associated with stress and distress in people living with diabetes: Results from the Colive Voice study", "type": "peer-reviewed", "updated_at": "2026-10-30T12:18:02Z", "url": "https://research.draconitic.com/paper/bfc1zftvpzgp8", "venue": "PLOS Digital Health", "versions": [] }