Oral Antidiabetics and Sleep Among Type 2 Diabetes Patients: Data From the UK Biobank

Abstract

Previous small-scale studies have found that oral antidiabetic therapy is associated with sleep difficulties among patients with type 2 diabetes (T2D). Here, we used data from 11 806 T2D patients from the UK Biobank baseline investigation to examine the association of oral antidiabetic therapy with self-reported difficulty falling and staying asleep and daily sleep duration. As shown by logistic regression adjusted for, e.g., age, T2D duration, and HbA1c, patients on non-metformin therapy (N=815; 86% were treated with sulphonylureas) had a 1.24-fold higher odds ratio of reporting regular difficulty falling and staying asleep at night compared to those without antidiabetic medication use (N=5 366, P<0.05) or those on metformin monotherapy (N=5 625, P<0.05). Non-metformin patients reported about 8 to 10 minutes longer daily sleep duration than the other groups (P<0.05). We did not find significant differences in sleep outcomes between untreated and metformin patients. Our findings suggest that non-metformin therapy may result in sleep initiation and maintenance difficulties, accompanied by a small but significant sleep extension. The results of the present study must be replicated in future studies using objective measures of sleep duration and validated questionnaires for insomnia. Considering that most T2D patients utilize multiple therapies to manage their glycemic control in the long term, it may also be worth investigating possible interactions of antidiabetic drugs on sleep.

Sleep behavior and daily activity levels in people with metabolic syndrome: effect of 1 year of metformin treatment

“…About type 2 diabetes, a study on 387 outpatients found that patients treated with metformin slept for approximately 36 min longer and exhibited a 6.4% higher sleep efficiency compared with other treatments (28). Consistently, a cross-sectional study on 11,806 diabetic patients showed that those treated with non-metformin drugs were more likely to report difficulty falling and staying asleep at night compared with those on metformin monotherapy (31). Our results are consistent with these observations.…”

“…Previous studies have supported a protective association between sleep and metformin in people with type 2 diabetes or polycystic ovarian syndrome (29)(30)(31). About type 2 diabetes, a study on 387 outpatients found that patients treated with metformin slept for approximately 36 min longer and exhibited a 6.4% higher sleep efficiency compared with other treatments (28).…”

“…In addition, it seems that MET is able to reduce sleep apnea in diabetes mellitus patients ( 29 ) and sleep disorders and daytime sleepiness in girls with polycystic ovarian syndrome ( 30 ). Xue et al ( 31 ) showed that diabetics treated with MET have fewer sleep problems, but sleep less than the non-MET group ( 31 ). Conversely, Wiwanitkit and Wiwanitkit ( 29 ) reported that MET could induce insomnia and nightmares.…”

Intermittent Hypoxia Interferes with Autocrine Effects of GABA on Insulin Secretion in Postnatal Rodents—Implications for Pediatric Obstructive Sleep Apnea

“…If GABA compensates for hypoinsulinemia during postprandial conditions in pediatric patients with hypopnea or periodic breathing, GABA could play a useful remedial role. This set of new information would be useful for studying the interactions of antidiabetic drugs and sleep, as discussed by others [ 13 ].…”

“…Maintaining insulin levels via GABA effects is more challenging for patients with OSA, because GABA influences insulin secretion under IH conditions induced by OSA, which could be unsafe; GABA also plays sedative roles that may further compromise breathing. Furthermore, a recent study on large samples of adult patients reported a higher odds ratio of up to 24% of sleep disturbance amongst patients taking non-metformin in comparison with those without antidiabetics [ 13 ], raising concerns of GABA’s effects on state transitions to sleep.…”