Sleep Duration, Lifestyle Intervention, and Incidence of Type 2 Diabetes in Impaired Glucose Tolerance

Abstract

OBJECTIVEBoth short and long sleep duration have frequently been found to be associated with an increased risk for diabetes. The aim of the present exploratory analysis was to examine the association between sleep duration and type 2 diabetes after lifestyle intervention in overweight individuals with impaired glucose tolerance in a 7-year prospective follow-up.RESEARCH DESIGN AND METHODSA total of 522 individuals (aged 40–64 years) were randomly allocated either to an intensive diet-exercise counseling group or to a control group. Diabetes incidence during follow-up was calculated according to sleep duration at baseline. Sleep duration was obtained for a 24-h period. Physical activity, dietary intakes, body weight, and immune mediators (C-reactive protein and interleukin-6) were measured.RESULTSInteraction between sleep duration and treatment group was statistically significant (P = 0.003). In the control group, the adjusted hazard ratios (HRs) (95% CI) for diabetes were 2.29 (1.38–3.80) and 2.74 (1.67–4.50) in the sleep duration groups 9–9.5 h and ≥10 h, respectively, compared with for that of the 7–8.5 h group. In contrast, sleep duration did not influence the incidence of diabetes in the intervention group; for sleep duration groups 9–9.5 h and ≥10 h, the adjusted HRs (95% CI) were 1.10 (0.60–2.01) and 0.73 (0.34–1.56), respectively, compared with that in the reference group (7–8.5 h sleep). Lifestyle intervention resulted in similar improvement in body weight, insulin sensitivity, and immune mediator levels regardless of sleep duration.CONCLUSIONSLong sleep duration is associated with increased type 2 diabetes risk. Lifestyle intervention with the aim of weight reduction, healthy diet, and increased physical activity may ameliorate some of this excess risk.

Sleep Duration and Risk of Type 2 Diabetes: A Meta-analysis of Prospective Studies

“…After evaluating the full texts of these 14 publications, we further excluded 4 articles (10,11,28,29) due to a lack of sufficient data for estimation of dose-response analysis. In addition, we included the report of the control group, and not the intervention group, in the study by Tuomilehto et al (18). In the study by Kita et al (16), the results were separated according to the presence or absence of a family history of diabetes (FHD), so we treated it as two separate reports.…”

“…In addition, without a dose-response analysis, it remains unknown how many hours of habitual sleep are associated with the lowest risk of type 2 diabetes. In the past several years, the number of prospective studies with enough quantitative categories has nearly doubled (13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Therefore, we conducted a meta-analysis of prospective studies to determine the overall shape of the relationship between sleep duration and risk of type 2 diabetes.…”

Identification of depression in diabetes: the efficacy of PHQ-9 and HADS-D

“…There is a complicated relationship between obesity, diabetes, depression, and obstructive sleep apnoea. 18,19 Sleep disturbances in diabetes are frequently due to nocturia, neurogenic pain, and other causes. 20,21 The PHQ-9 questions about over eating or under eating, and the somatic symptom of tiredness may be accounted for by diabetes itself, or by sleep disturbances including obstructive sleep apnoea, and could account for the high classification rate for moderate to severe depression.…”

The role of sleep duration in diabetes and glucose control

“…Proceedings of the Nutrition Society developing T2DM, studied over varying lengths of followup (7)(8)(9)(10)(11)(12)(13)(14)(15)(16) . Details of their study design and outcomes are shown in Table 1.…”

“…Another prospective study examined the association of sleep duration with development of impaired fasting glucose over 6 years follow-up (11) , with 6-8 h sleep duration as a reference category, short (but not long) sleepers had higher odds of developing impaired fasting glucose (OR 3·0, 95 % CI 1·05, 8·59; OR 1·6, 95 % CI 0·45, 5·42 for short and long sleep durations, respectively). A Finnish study in overweight individuals with impaired glucose tolerance found an increased risk of T2DM only in participants with long sleep duration ⩾9 h (hazard ratio (HR) 2·29, 95 % CI 1·38, 3·80) (14) . Finally, two recent meta-analyses of nine (17) and fourteen (18) prospective cohort studies have also confirmed the U-shaped relationship (Fig.…”