Sleep and glycemic control in type 1 diabetes

Barone, Mark Thomaz Ugliara; Wey, Daniela; Schorr, Fabíola; Franco, Denise Reis; Carra, Mario Kehdi; Lorenzi-Filho, Geraldo; Menna‐Barreto, Luiz

doi:10.1590/2359-3997000000013

Cited by 41 publications

(59 citation statements)

References 32 publications

(40 reference statements)

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“…Similarly, Barone and colleagues showed that glycemic control modified the relationship between actimeter-measured sleep duration and glycemia in a small T1D study (n=18) [44]. Specifically, among individuals with T1D and HbA 1c <7%/53 mmol/mol, a strong negative correlation between glycemia and the night rest duration was observed (r= −0.90, p=0.04).…”

Section: Discussionmentioning

confidence: 88%

Subjective sleep disturbances and glycemic control in adults with long-standing type 1 diabetes: The Pittsburgh’s Epidemiology of Diabetes Complications study

Denic-Roberts

Costacou

Orchard

2016

Diabetes Research and Clinical Practice

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Aims To date, studies on sleep disturbances in type 1 diabetes (T1D) have been limited to youth and/or small samples. We therefore assessed the prevalence of subjective sleep disturbances and their associations with glycemia and estimated insulin sensitivity in individuals with longstanding T1D. Methods We conducted a cross-sectional study including 222 participants of the Epidemiology of Diabetes Complications study of childhood-onset T1D attending the 25-year examination (mean age=52 years, diabetes duration=43 years). The Berlin Questionnaire (risk of obstructive sleep apnea, OSA), the Epworth Sleepiness Scale (daytime sleepiness), and the Pittsburgh Sleep Quality Index (sleep quality, bad dreams presence, and sleep duration) were completed. Associations between sleep disturbances and poor glycemic control (HbA1c ≥7.5%/58 mmol/mol), log-transformed HbA1c, and estimated insulin sensitivity (estimated glucose disposal rate, eGDR, squared) were assessed in multivariable regression. Results The prevalences of high OSA risk, excessive daytime sleepiness, poor sleep quality, and bad dreams were 23%, 13%, 41%, and 26%, respectively, with more women (51%) reporting poor sleep quality than men (30%, p=0.004). Participants under poor glycemic control were twice as likely to report bad dreams (p=0.03), but not independently (p=0.07) of depressive symptomatology. Sleep duration was directly associated with HbA1c among individuals with poor glycemic control, but inversely in their counterparts (interaction p=0.002), and inversely associated with eGDR (p=0.002). Conclusions These findings suggest important interrelationships between sleep, gender, depressive symptomatology, and glycemic control, which may have important clinical implications. Further research is warranted to examine the mechanism of the interaction between sleep duration and glycemic control.

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Section: Discussionmentioning

confidence: 88%

Subjective sleep disturbances and glycemic control in adults with long-standing type 1 diabetes: The Pittsburgh’s Epidemiology of Diabetes Complications study

Denic-Roberts

Costacou

Orchard

2016

Diabetes Research and Clinical Practice

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“…Hypoglycaemia, based on SMBG readings, was not related to sleep variables in this study (data not shown), which could be due to a limitation of SMBG in reflecting fluctuations in glucose levels typically seen in T1D. In addition, glycaemic variability was not assessed (by continuous glucose monitoring), although it was shown to be related to sleep impairment in one study (Barone et al ., ). When using the SD of SMBG values as an indicator of glycaemic variability, no associations with sleep variables were found (data not shown).…”

Section: Discussionmentioning

confidence: 97%

Higher sleep variability is associated with poorer glycaemic control in patients with type 1 diabetes

Chontong

Saetung

Reutrakul

2016

Journal of Sleep Research

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Summary Sleep disturbances have been linked to insulin resistance and poor glycaemic control in patients with type 2 diabetes. However, the data are limited in type 1 diabetes. Recently, varying day‐to‐day sleep schedules, i.e. sleep variability, have been associated with adverse metabolic profile in healthy individuals. This study explored whether sleep variability affects glycaemic control and insulin requirement in type 1 diabetes. Forty‐one adult patients with type 1 diabetes wore an actigraphy for 5 nights. Standard deviation of sleep duration, efficiency and mid‐sleep time were sleep variability parameters. Sleep apnoea risk and self‐reported sleep quality were assessed by the Berlin questionnaire and Pittsburgh Sleep Quality Index. Haemoglobin A1c, diabetes complications and insulin regimen were obtained from medical records. After adjusting for neuropathic symptoms, sleep apnoea risk and poor self‐reported sleep quality, higher sleep variability was significantly associated with poorer glycaemic control (standard deviation of sleep duration, B = 0.100, P = 0.004; and standard deviation of mid‐sleep time, B = 0.068, P = 0.04). In addition, standard deviations of sleep duration and mid‐sleep time were highly correlated, suggesting that participants changed their sleep duration along with sleep timing. After adjusting for covariates, the standard deviation of sleep duration (P = 0.009) and standard deviation of mid‐sleep time (P = 0.012) were associated with higher insulin requirement. In summary, higher sleep variability, which likely reflects sleep deprivation alternating with sleep compensation along with shifts in their circadian timing, was associated with poorer glycaemic control and higher insulin requirement in patients with type 1 diabetes. Increased sleep regularity may improve metabolic control in type 1 diabetes.

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“…In these pilot studies, HbA1c was not clearly associated with the presence of sleep apnea; however, some data suggest that arousal index, assessed by polysomnography, could be linked to glycemic control (34). We therefore included an oximetric recording in the patients' sleep evaluation.…”

Section: Discussionmentioning

confidence: 99%

Impact of sleep behavior on glycemic control in type 1 diabetes: the role of social jetlag

Larcher

Gauchez

Lablanche

et al. 2016

European Journal of Endocrinology

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Background: Sleep behavior is changing toward shorter sleep duration and a later chronotype. It results in a sleep debt that is acquitted on work-free days, inducing a small but recurrent sleep misalignment each week, referred to as "social jetlag". These sleep habits could affect health through misalignment with circadian rhythms. Objectives: The primary objective is to address the impact of sleep behavior on glycemic control, assessed by HbA1c, in patients with type 1 diabetes, independently of other lifestyle or sleep-related factors. The secondary objective is to address whether circadian phase affects glycemic control. Design: In total, 80 adult patients with type 1 diabetes (46% female) were included in a clinical cohort study. Methods: Sleep behavior was addressed objectively by a 7-day actimetry, lifestyle by questionnaires, sleep breathing disorders by nocturnal oximetry and circadian phase by dim light melatonin onset (DLMO). Results: Univariate analyses showed that chronotype (r = 0.23, P = 0.042) and social jetlag (r = 0.30, P = 0.008) were significantly associated with HbA1c. In multivariable analysis, social jetlag was the only sleep habit independently associated with HbA1c (β = 0.012 (0.006; 0.017), P < 0.001). HbA1c was lower in patients with a social jetlag below versus above the median (7.7% (7.1-8.7) and 8.7% (7.6-9.8), P = 0.011). DLMO was not associated with HbA1c. However, the later the DLMO, the worse the sleep efficiency (r = −0.41, P < 0.001) and fragmentation index (r = 0.35, P = 0.005). Conclusions: Social jetlag, a small but recurrent circadian misalignment, is associated with worse glycemic control in type 1 diabetes, whereas circadian phase is not. Further intervention studies should address the potential improvement of glycemic control by correcting social jetlag.

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Sleep and glycemic control in type 1 diabetes

Cited by 41 publications

References 32 publications

Subjective sleep disturbances and glycemic control in adults with long-standing type 1 diabetes: The Pittsburgh’s Epidemiology of Diabetes Complications study

Subjective sleep disturbances and glycemic control in adults with long-standing type 1 diabetes: The Pittsburgh’s Epidemiology of Diabetes Complications study

Higher sleep variability is associated with poorer glycaemic control in patients with type 1 diabetes

Impact of sleep behavior on glycemic control in type 1 diabetes: the role of social jetlag

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