Nocturnal growth hormone surges in type 1 diabetes mellitus are both sleep- and glycemia-dependent: assessment under continuous sleep monitoring

Assessment of clinical impact of SARS-CoV-2 in people with type 1 diabetes: A cohort study

OBJECTIVES

During the coronavirus 2019 pandemic, there had been more than 758 million COVID-19 cases as of February 13, 2023, and it is the main cause of death in many countries. Due to the variation in disease presentation, scientists determined that people living with type 2 diabetes mellitus were at higher risk of mortality. However, people living with type 1 diabetes have not been thoroughly studied, especially in extreme regions of developing countries. The objective of this study was to analyze the effects of SARS-CoV-2 pandemic restrictions on different variables in a cohort with type 1 diabetes.

METHODS

This cohort-type study included pediatric and adult patients with type 1 diabetes at Regional Hospital Dr. Juan Noé Crevani in Arica, Chile. Biosocial and anthropometric factors, clinical history, self-care activities, and biochemical parameters were assessed and compared using analysis of variance and paired t tests between March 2020 and March 2021.

RESULTS

A total of 150 patients were assessed during the SARS-CoV-2 pandemic in Arica, Chile. One year after the pandemic struck, the main causes for metabolic deterioration were a reduction of carbohydrate counting by an average of 8.67% (P = 0.000), a reduction of adherence to treatment by an average of 25% (P = 0.000), and a shift to telemedicine as a main health care service (P = 0.023); these factors raised hemoglobin A1c (HbA1c) levels by 1.81%, 1.78% and 0.075%, respectively. The participants' average body mass index (BMI) increased by 1.26 kg/m2 and HbA1c levels increased by 0.16% during the first year of the pandemic. Also, hospitalizations increased about 2% (P = 0.984), and there was a significant increase in carbohydrate and snack intake (P = 0.330 and P = 0.811, respectively). Children's linear growth decreased by a standard deviation of 0.035 (P = 0.648), and their physical activity decreased by 12.67% (P = 0.383).

CONCLUSIONS

This study found that adherence to diabetes care was reduced during the pandemic owing to a variety of behavioral reasons and environmental changes (e.g., quarantines and food security). This affected this population's HbA1c levels, BMI, linear growth, and number of hospitalizations as main consequences. Telemedicine remains an important tool, but it must be reconsidered among all different age groups.

Sleep-related disorders in patients with type 1 diabetes mellitus: current insights

Type 1 diabetes mellitus (T1DM) is an autoimmune condition that results from destruction of beta cells in the pancreas. Several reviews have concluded that sleep contributes to poor glycemic control, diabetes management, and diabetes-related complications in individuals with T1DM and represents an untapped opportunity for intervention. However, at the current juncture, the American Diabetes Association's Standards of Medical Care are devoid of recommendations about how to address sleep in the management of T1DM. This article summarizes reviews of sleep in youth and adults with T1DM and empirical studies that have examined various sleep parameters ranging from sleep disturbances (general, perceived sleep quality, sleepiness, awakenings, and sleep efficiency), sleep duration, sleep consistency, sleep-disordered breathing (SDB), and sleep architecture. The data show that many individuals with T1DM sleep less than recommendations; individuals with the poorest sleep have difficulties with diabetes management; and sleep deficiency including SDB often corresponds to several disease morbidities (neuropathy, nephropathy, etc). Mixed findings exist regarding direct associations of various sleep parameters and glycemic control. SDB appears to be just as prevalent, if not more, than other conditions that have been recommended for universal screening in individuals with T1DM. The article concludes with recommendations for collaborative research efforts to further elucidate the role of sleep in diabetes-related outcomes; investigations to test behavioral strategies to increase sleep quantity and consistency; and considerations for clinical care to address sleep.

Short-term metabolic control and sleep in children and adolescents with type 1 diabetes mellitus

AIMS

The aim of this study was to examine sleep in T1D children and in healthy controls by polysomnographic (PSG) examination and to determine the influence of short-term metabolic compensation on sleep quality and sleep disordered breathing (SDB).

METHODS

The prospective cross-sectional study included 44 T1D subjects and 60 healthy controls, aged 10-19 years. Subjects underwent anthropometric measurements, laboratory testing and standard overnight in-laboratory video polysomnography with continuous glucose monitoring (CGM).

RESULTS

No significant differences were found in total sleep time, sleep efficiency, percentage of sleep stages and respiratory parameters between T1D and healthy group. T1D children with more optimal short-term metabolic control (AvgSG < 10 mmol/l, n = 18) had a significantly lower apnea-hypopnea index (AHI) (0.3(0-0.5) vs. 0.6 (0.2-0.9) events/h, p < 0.05)and respiratory arousal index (0(0-0,1) vs. 0.2(0-0.3)), p < 0.01) compared to children with suboptimal short-term control(n = 26), no significant differences were found in parameters of sleep architecture. Obstructive sleep apnea (OSA) was diagnosed in only one T1D patient, nine T1D children had mild central apnea.

CONCLUSIONS

There may be an association between short-term metabolic compensation and SDB in T1D children without chronic complications, obesity or overweight and hypoglycemia. Further research is needed to confirm this result.

Nocturnal continuous glucose and sleep stage data in adults with type 1 diabetes in real-world conditions

BACKGROUND

Sleep plays an important role in health, and poor sleep is associated with negative impacts on diabetes management, but few studies have objectively evaluated sleep in adults with type 1 diabetes mellitus (T1DM). Nocturnal glycemia and sleep characteristics in T1DM were evaluated using body-worn sensors in real-world conditions.

METHODS

Analyses were performed on data collected by the Diabetes Management Integrated Technology Research Initiative pilot study of 17 T1DM subjects: 10 male, 7 female; age 19-61 years; T1DM duration 14.9 ± 11.0 years; hemoglobin A1c (HbA1c) 7.3% ± 1.3% (mean ± standard deviation). Each subject was equipped with a continuous glucose monitor and a wireless sleep monitor (WSM) for four nights. Sleep stages [rapid eye movement (REM), light, and deep sleep] were continuously recorded by the WSM. Nocturnal glycemia (mg/dl) was evaluated as hypoglycemia (<50 mg/dl), low (50-69 mg/dl), euglycemia (70-120 mg/dl), high (121-250 mg/dl), and hyperglycemia (>250 mg/dl) and by several indices of glycemic variability. Glycemia was analyzed within each sleep stage.

RESULTS

Subjects slept 358 ± 48 min per night, with 85 ± 27 min in REM sleep, 207 ± 42 min in light sleep, and 66 ± 30 min in deep sleep (mean ± standard deviation). Increased time in deep sleep was associated with lower HbA1c (R2 = 0.42; F = 9.37; p < .01). Nocturnal glycemia varied widely between and within subjects. Glycemia during REM sleep was hypoglycemia 5.5% ± 18.1%, low 6.6% ± 18.5%, euglycemia 44.6% ± 39.5%, high 37.9% ± 39.7%, and hyperglycemia 5.5% ± 21.2%; glycemia during light sleep was hypoglycemia 4.8% ± 12.4%, low 7.3% ± 12.9%, euglycemia 42.1% ± 33.7%, high 39.2% ± 34.6%, and hyperglycemia 6.5% ± 20.5%; and glycemia during deep sleep was hypoglycemia 0.5% ± 2.2%, low 5.8% ± 14.3%, euglycemia 48.0% ± 37.5%, high 39.5% ± 37.6%, and hyperglycemia 6.2% ± 19.5%. Significantly less time was spent in the hypoglycemic range during deep sleep compared with light sleep (p = .02).

CONCLUSIONS

Increased time in deep sleep was associated with lower HbA1c, and less hypoglycemia occurred in deep sleep in T1DM, though this must be further evaluated in larger subsequent studies. Furthermore, the consumer-grade WSM device was useful for objectively studying sleep in a real-world setting.

Sleep, glucose, and daytime functioning in youth with type 1 diabetes

STUDY HYPOTHESES: 1) Youth with evidence of SDB (total apnea-hypopnea index [Total-AHI] ≥ 1.5) would have significantly worse glucose control than those without SDB; 2) Elevated self-reported sleepiness in youth with T1DM would be related to compromised psychosocial functioning; and 3) Youth with T1DM would have significantly less slow wave sleep (SWS) than controls.

DESIGN

The study utilized home-based polysomnography, actigraphy, and questionnaires to assess sleep, and continuous glucose monitors and hemoglobin A1C (HbA1C) values to assess glucose control in youth with T1DM. We compared sleep of youth with T1DM to sleep of a matched control sample.

SETTING

Diabetic participants were recruited in a pediatric endocrinology clinic.

PARTICIPANTS

Participants were youth (10 through 16 years) with T1DM. Controls, matched for sex, age, and BMI percentile, were from the Tucson Children's Assessment of Sleep Apnea study.

RESULTS

Participants with a Total-AHI ≥ 1.5 had higher glucose levels. Sleepiness and/or poor sleep habits correlated with reduced quality of life, depressed mood, lower grades, and lower state standardized reading scores. Diabetic youth spent more time (%) in stage N2 and less time in stage N3. Findings related to sleep architecture included associations between reduced SWS and higher HbA1C, worse quality of life, and sleepiness. More time (%) spent in stage N2 related to higher glucose levels/hyperglycemia, behavioral difficulties, reduced quality of life, lower grades, depression, sleep-wake behavior problems, poor sleep quality, sleepiness, and lower state standardized math scores.

Altered neuroendocrine sleep architecture in patients with type 1 diabetes

OBJECTIVE

The modulatory influence of nocturnal sleep on neuroendocrine secretory activity is increasingly recognized as a factor critical to health. Disturbances of sleep may arise from and contribute to the disease process in chronically ill patients with type 1 diabetes.

RESEARCH DESIGN AND METHODS

Using standard polysomnography and repetitive blood sampling, neuroendocrine sleep architecture was assessed under well-controlled nonhypoglycemic conditions in 14 type 1 diabetic patients and 14 healthy control subjects matched for age, sex, and BMI.

RESULTS

As expected, plasma glucose (P = 0.02) and serum insulin (P < 0.001) levels were constantly higher in type 1 diabetic patients than in healthy subjects throughout the night. Beside these characteristic alterations of glucose metabolism, type 1 diabetic patients displayed higher blood levels of growth hormone (P = 0.001) and epinephrine (P = 0.02) during the entire night and higher levels of ACTH (P = 0.01) as well as a tendency toward higher cortisol levels (P = 0.072) during the first night-half, compared with healthy control subjects. Patients spent slightly less time in slow wave sleep (P = 0.09) during the first night-half (where this sleep stage predominates), and overall exhibited an increased proportion of stage 2 sleep (P = 0.01). Correspondingly, assessment of mood and symptoms after sleep revealed that subjective sleep was less restorative in type 1 diabetic patients than in healthy subjects.

CONCLUSIONS

Our data indicate distinct alterations in the neuroendocrine sleep architecture of patients with type 1 diabetes, which add to the generally adverse impact of the disease on the patients' health.

A comparison of the use of premixed insulins in pen-injectors with conventional patient-mixed insulin treatment in children and adolescents with IDDM. Is there a decreased risk of night hypoglycemia?

Insulin injection is a problem in pediatric and adolescent age, and premixed insulin therapy given in pen-injectors (Novopen II) is expected to increase compliance. Compliance with treatment and safety of this kind of insulin substitution was investigated in 20 IDDM patients (8.2-19.6 years old). The study was of randomized cross-over design and its duration was 6 (2x3) months. Metabolic parameters were compared between premixed insulin therapy via pen-injector and patient-mixed insulin therapy via conventional syringe, and no differences were observed except for the postponing of night hypoglycemic attacks to 07.00 a.m. during premixed insulin therapy. No technical or medical problems occurred. Patients were more satisfied with the new therapy regimen as determined by questionnaire. We concluded that this kind of insulin substitution is safe in pediatric and adolescent IDDM patients.