Partial Sleep Restriction Decreases Insulin Sensitivity in Type 1 Diabetes.

Abstract

OBJECTIVE -Sleep restriction results in decreased insulin sensitivity and glucose tolerance in healthy subjects. We hypothesized that sleep duration is also a determinant of insulin sensitivity in patients with type 1 diabetes.RESEARCH DESIGN AND METHODS -We studied seven patients (three men, four women) with type 1 diabetes: mean age 44 Ϯ 7 years, BMI 23.5 Ϯ 0.9 kg/m 2 , and A1C 7.6 Ϯ 0.3%. They were studied once after a night of normal sleep duration and once after a night of only 4 h of sleep. Sleep characteristics were assessed by polysomnography. Insulin sensitivity was measured by hyperinsulinemic euglycemic clamp studies with an infusion of [6,6-2 H 2 ]glucose.RESULTS -Sleep duration was shorter in the night with sleep restriction than in the unrestricted night (469 Ϯ 8.5 vs. 222 Ϯ 7.1 min, P ϭ 0.02). Sleep restriction did not affect basal levels of glucose, nonesterified fatty acids (NEFAs), or endogenous glucose production. Endogenous glucose production during the hyperinsulinemic clamp was not altered during the night of sleep restriction compared with the night of unrestricted sleep (6.2 Ϯ 0.8 vs. 6.9 Ϯ 0.6 mol ⅐ kg lean body mass Ϫ1 ⅐ min Ϫ1 , NS). In contrast, sleep restriction decreased the glucose disposal rate during the clamp (25.5 Ϯ 2.6 vs. 22.0 Ϯ 2.1 mol ⅐ kg lean body mass Ϫ1 ⅐ min Ϫ1 , P ϭ 0.04), reflecting decreased peripheral insulin sensitivity. Accordingly, sleep restriction decreased the rate of glucose infusion by ϳ21% (P ϭ 0.04). Sleep restriction did not alter plasma NEFA levels during the clamp (143 Ϯ 29 vs. 133 Ϯ 29 mol/l, NS).CONCLUSIONS -Partial sleep deprivation during a single night induces peripheral insulin resistance in these seven patients with type 1 diabetes. Therefore, sleep duration is a determinant of insulin sensitivity in patients with type 1 diabetes.

Subjective sleep impairment in adults with type 1 or type 2 diabetes: Results from Diabetes MILES—The Netherlands

“…These findings are consistent with epidemiological studies showing that poor sleep quality and both short and long sleep duration are associated with higher glycated haemoglobin (HbA 1c ) levels in adults with type 2 diabetes [3,5,12,13]. Also in adults with type 1 diabetes, experimental partial sleep restriction lowers insulin sensitivity [14]. In another study, short sleep duration measured by wrist actimetry has been shown to be associated with a 0.64% (7 mmol/mol) increase in HbA 1c level in adults with type 1 diabetes [15], while selfreported sleep duration and sleep quality showed no relation with HbA 1c [9].…”

Sleep Deprivation: Societal Impact and Long-Term Consequences

“…In the early part of the day, after 2 days of short bedtimes, glucose levels were higher and insulin levels were lower than after 2 days of longer bedtimes. These findings have since been replicated in other studies that have shown that sleep deprivation can lead to insulin dysregulation [84][85][86].…”

Sleep and glycemic control in type 1 diabetes

“…control in t. 1 diabetes function, and neuro-hormonal regulation (21)(22)(23)(24)(25)(26). Concerning specifically T1DM, a study revealed that a single partially deprived night is enough to produce insulin resistance (27). In this study individuals were allowed to sleep for 4 hours at night, and in the following day their insulin sensitivity was reduced in 14-21%.…”