Sleep disruption in adolescents with Type 1 diabetes mellitus: relationships with adherence and diabetes control

Abstract

aim: To examine the relationship of sleep disturbance with adherence and glycemic control in adolescents with Type 1 diabetes mellitus. materials & methods: Participants included 72 adolescents in poor metabolic control. Parents reported on the frequency of the following sleep disturbances: sleeping too much, not sleeping enough, trouble sleeping and being overtired. Adherence was assessed via self-report and frequency of blood glucose monitoring. Glycemic control was assessed via hemoglobin A1c and continuous glucose monitoring data. results: Sleeping more was associated with lower adherence and higher HbA1c. Sleeping more and trouble sleeping were associated with hyperglycemia as measured by continuous glucose monitoring. Conclusion: Sleep disturbance may negatively impact adherence and glycemic control. Additional research is needed to determine directionality of relationships. Practice points• Adherence to diabetes care is particularly problematic during adolescence for young people with Type 1 diabetes mellitus (T1D).• Difficulties with sleep have a known impact on cognitive and executive functioning, which is important for adherence. However, research has not yet examined relationships between sleep disturbance and adherence for adolescents with T1D.• The current study aimed to examine relationships of sleep disturbance with adherence and glycemic control in adolescents with T1D.• Participants included 72 adolescents between the ages of 10 and 18 years, who had poor diabetes control.• Parents reported on adolescent sleep disturbance, self-report and frequency of blood glucose monitoring were used to assess adherence, and HbA1c and results of continuous glucose monitoring were used to assess glycemic control.• Sleeping too much and trouble sleeping were associated with hyperglycemia. Sleeping too much was also associated with lower adherence and higher HbA1c.• Sleep variables collectively explained 16% of the variance in adherence and 15% of the variance in average CGM glucose levels.• Associations of sleep disturbance with adherence suggests the importance of assessing sleep and also highlights the need for future research on methods to improve sleep for adolescents with T1D.For reprint orders, please contact: reprints@futuremedicine.com

Sleep in Type 1 Diabetes: Implications for Glycemic Control and Diabetes Management

“…In one study of adolescents with T1D, parents revealed that 15% of their children had trouble sleeping, 22% were overtired during the day, 29% believed they slept more than children without T1D, and 18% believed they slept less than children without T1D [8]. Similarly, compared to a control group of healthy children, parents have reported that children with T1D had more sleep problems, including more issues surrounding sleep initiation and maintenance, the sleep-wake transition, and daytime sleepiness [•9].…”

“…Interestingly, participants considered to be in poor glycemic control were found to be twice as likely to report trouble sleeping due to bad dreams, suggesting that poor glycemic control may negatively impact the quality of REM sleep [10]. Similarly, trouble sleeping, such as difficulty with sleep initiation and night awakenings, was related to glycemic control in both children and adults with T1D [8, 11]. Given that many of these studies were cross-sectional, it is difficult to determine whether poor glycemic control led to sleep disturbances or vice versa; it is likely that the relationship is bidirectional [12].…”

“…Hazen and colleagues found that, in addition to poorer glycemic control and higher average BG levels, parent report of sleeping more than other children was associated with less frequent BG checks, and lower self-reported adherence [8]. The act of sleeping too much may preclude engagement in some adherence behaviors, as children may be asleep at times that they are required to check BG or administer insulin.…”

“…In a study of adolescents with poorly controlled T1D, trouble sleeping, overtiredness, and sleeping more than other children were linked with higher levels of depressive symptoms [8]. Similarly, in a study reporting that children with T1D had a higher incidence of problem behaviors, problems sleeping, and reduced executive functioning, sleep difficulties were found to mediate the effects of diabetes on externalizing behavior, internalizing behavior, and metacognition [•9].…”

“…Further, both poorer sleep quality and shorter self-reported sleep duration (less than 6 hours/night) were related to poorer glycemic control, with a mean difference in hemoglobin A1c (HbA1c) of 0.19% and 0.24%, respectively. On the other hand, excessive sleeping has also been linked to hyperglycemia in adolescents with T1D [8]. Taken together, these findings suggest that obtaining sleep outside the recommended range (whether too little or too much) may have a negative impact on glycemic control.…”