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Bowen AE, Holtman S, Reich J, Simon SL. Supporting healthy sleep: a qualitative assessment of adolescents with type 1 diabetes and their parents. J Pediatr Psychol 2024:jsae055. [PMID: 38994904 DOI: 10.1093/jpepsy/jsae055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 07/13/2024] Open
Abstract
OBJECTIVE Poor sleep health is common in adolescence due to a combination of physiological, psychosocial, and environmental factors. Adolescents with type 1 diabetes (T1D) may be at increased risk for poor sleep health due to physiological and behavioral aspects of diabetes and its management. This article describes a qualitative analysis of interviews with adolescents with T1D and their parents about facilitators and barriers to sleep health and family strategies to balance teens' sleep with competing demands. METHODS Separate interviews were conducted with 20 adolescents with T1D and 20 parents. Interviews were recorded and transcribed verbatim and analyzed thematically. Participants were on average 15.8 ± 1.2 years old, 45% female, and 85% non-Hispanic White. RESULTS Overnight diabetes management was the most frequently reported barrier to sleep. Families reported different strategies for taking responsibility of overnight diabetes management, which differentially impacted sleep. Families worked to balance diabetes management and sleep with other aspects of adolescent life, including school demands, social activities, and electronics use. Facilitators to healthy sleep identified by families included diabetes assistive technology and maintaining a consistent sleep/wake schedule. Both adolescents and parents voiced beliefs that their diabetes care team is not able to help with sleep health. CONCLUSIONS Pediatric psychologists should be aware of the specific sleep barriers experienced by adolescents with T1D and their parents. A focus on overnight diabetes management strategies may facilitate psychologists' support of families in the adolescent's transition to independent diabetes management. Research is needed on the impact of optimizing sleep health in adolescents with T1D.
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Affiliation(s)
- Anne E Bowen
- Division of Pediatrics, Department of Pulmonology and Sleep Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Sydney Holtman
- Division of Pediatrics, Department of Pulmonology and Sleep Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jennifer Reich
- Department of Sociology, University of Colorado Denver, Denver, CO, United States
| | - Stacey L Simon
- Division of Pediatrics, Department of Pulmonology and Sleep Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Pulmonology and Sleep Medicine, Children's Hospital Colorado, Aurora, CO, United States
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2
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Núñez-Baila MÁ, Gómez-Aragón A, González-López JR. Perceptions of Emerging Adults With Type 1 Diabetes Mellitus on How the Condition Influences Sleep Quality: A Qualitative Study. J Diabetes Res 2024; 2024:7497059. [PMID: 39022652 PMCID: PMC11254458 DOI: 10.1155/2024/7497059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 04/04/2024] [Accepted: 06/20/2024] [Indexed: 07/20/2024] Open
Abstract
Background: Emerging adulthood is a phase characterized by exploration which potentially affecting sleep quality. While many emerging adults are healthy, the effects of chronic diseases such as Type 1 Diabetes Mellitus (T1DM) on sleep may be underestimated. Considering the frequency of nocturnal glycemic alterations that cause awakenings, this study explored the perceptions of emerging adults in Andalusia on the influence of T1DM on their sleep quality. Methods: A qualitative approach was used for this study. Purposive sampling through diabetes associations was initially utilized, supplemented by snowball sampling, in order to conduct semistructured interviews with 73 emerging adults (aged 18-29) diagnosed with T1DM, to explore their perceptions of the influence of T1DM on sleep quality. Interpretative Phenomenological Analysis was used for data analysis. Results: Sleep disruptions caused by overnight hyperglycemia and hypoglycemia were identified as significant factors. However, 62% of participants did not perceive the influence of diabetes on their sleep quality, despite experiencing frequent overnight glycemic alterations (reported by 40.9%). Conclusions: Perception of the impact of T1DM on sleep quality does not always align with the frequency of disruptions. Nonetheless, promoting healthy sleep and systematically assessing sleep quality can benefit both sleep and glycemic outcomes, regardless of individual perceptions.
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Affiliation(s)
- María-Ángeles Núñez-Baila
- Nursing DepartmentFaculty of NursingPhysiotherapy and PodiatryUniversidad de Sevilla, Seville, Spain
- Instituto de Biomedicina de SevillaIBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Anjhara Gómez-Aragón
- Nursing DepartmentFaculty of NursingPhysiotherapy and PodiatryUniversidad de Sevilla, Seville, Spain
- Instituto de Biomedicina de SevillaIBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - José Rafael González-López
- Nursing DepartmentFaculty of NursingPhysiotherapy and PodiatryUniversidad de Sevilla, Seville, Spain
- Instituto de Biomedicina de SevillaIBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
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Simon SL, Snell-Bergeon JK, Schäfer M, Barker AJ, Browne LP, Truong U, Tell SS, Vigers T, Baumgartner AD, Lyon E, Polsky S, Schauer IE, Nadeau KJ. Sleep duration and association with cardiometabolic health in adolescents and adults with type 1 diabetes: Results from the BCQR-T1D study. Diabetes Obes Metab 2024; 26:2662-2672. [PMID: 38584515 PMCID: PMC11150084 DOI: 10.1111/dom.15582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/15/2024] [Accepted: 03/17/2024] [Indexed: 04/09/2024]
Abstract
AIM Type 1 diabetes (T1D) increases the risk of morbidity and mortality from cardiovascular disease, and insufficient sleep is prevalent. Emerging evidence suggests a link between sleep and cardiometabolic health, but this has not been examined across the lifespan in individuals with T1D. We aimed to examine associations between sleep and cardiometabolic health in adolescents and adults with T1D in a secondary analysis of data from a 4-week double-blind, random-order, placebo-controlled crossover trial of bromocriptine quick release (BCQR) therapy with a 4-week washout in between conditions. MATERIALS AND METHODS Forty-two adults (19-60 years) and 42 adolescents (12-18 years) with T1D >9 months completed 1 week of home monitoring with wrist-worn actigraphy to estimate sleep duration and continuous glucose monitoring, anthropometrics, arterial stiffness, magnetic resonance imaging (adolescents only), and fasting laboratory testing at each treatment phase. RESULTS Sixty-two per cent of adolescents and 74% of adults obtained <7 h of sleep per night at baseline. After adjustment for age, sex and diabetes duration, baseline sleep <7 h per night was associated with a higher body mass index, a higher waist circumference, a higher systolic blood pressure, worse arterial stiffness and a lower estimated insulin sensitivity (all p < .05). When examined by age group, associations between sleep duration and cardiometabolic health outcomes remained significant, predominantly for adolescents. In adolescents only, wake time was significantly later (p = .027) and time in bed was significantly longer with BCQR versus placebo (p = .049). CONCLUSIONS Objectively measured sleep <7 h per night was prevalent in adolescents and adults with T1D and associated with poorer cardiometabolic health markers. Small changes in sleep were seen following BCQR treatment in adolescents only. Sleep may be an important and novel target for improving cardiometabolic health in individuals with T1D.
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Affiliation(s)
- Stacey L. Simon
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Janet K. Snell-Bergeon
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora CO USA
| | - Michal Schäfer
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Alex J Barker
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Lorna P Browne
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Uyen Truong
- Department of Cardiology, Children’s National Hospital, Washington, DC USA
| | - Shoshana S. Tell
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Timothy Vigers
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Amy D. Baumgartner
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Ellen Lyon
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO USA
| | - Sarit Polsky
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora CO USA
| | - Irene E. Schauer
- Department of Medicine, University of Colorado Anschutz Medical Campus and Endocrinology Section, Rocky Mountain Regional VA Medical Center, Aurora, CO USA
| | - Kristen J. Nadeau
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO USA
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4
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Wong JJ, Hood KK, Hanes SJ, Lal RA, Naranjo D. Psychosocial Effects of the Loop Open-Source Automated Insulin Delivery System. J Diabetes Sci Technol 2023; 17:1440-1447. [PMID: 35771004 PMCID: PMC10658689 DOI: 10.1177/19322968221105288] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AIMS This study examined the psychosocial impact of Loop, an open-source automated insulin dosing system that has emerged from the diabetes technology "Do-It-Yourself" (DIY) movement. METHODS Subsamples of 239 adults, 115 children, and 243 parents completed data collection at the time of Loop initiation and 3 and 6 months later. Surveys collected demographic and clinical information, percent time-in-range, HbA1c, and validated psychosocial measures. Analyses included paired t tests and McNemar's tests to compare psychosocial functioning at 3 and 6 months and regression models to assess baseline predictors of psychosocial outcomes at 6 months. RESULTS Adults reported significant improvements in diabetes distress (t = -7.20 P < .001; t = -8.01, P < .001), sleep quality (t = 6.81, P < .001; t = 2.98, P = .003), fear of hypoglycemia (t = -4.42, P < .001; t = -4.97, P < .001), and hypoglycemia confidence (t = 8.68, P < .001; t = 7.96 P < .001) from baseline to 3 months and 6 months, respectively. Significant improvements in parents' and children's sleep quality and parents' fear of hypoglycemia were also observed. Several baseline characteristics were associated with psychosocial outcomes at 6 months. CONCLUSIONS The current findings support the broad and sustained benefits of Loop across multiple aspects of psychosocial well-being. Advancement and dissemination of such technologies has the potential to improve mental and physiological health among people living with type 1 diabetes.
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Affiliation(s)
- Jessie J. Wong
- Division of Endocrinology and Diabetes,
Department of Pediatrics, Stanford University School of Medicine, Stanford, CA,
USA
| | - Korey K. Hood
- Division of Endocrinology and Diabetes,
Department of Pediatrics, Stanford University School of Medicine, Stanford, CA,
USA
- Stanford Diabetes Research Center,
Stanford University School of Medicine, Stanford, CA, USA
| | - Sarah J. Hanes
- Division of Endocrinology and Diabetes,
Department of Pediatrics, Stanford University School of Medicine, Stanford, CA,
USA
| | - Rayhan A. Lal
- Division of Endocrinology and Diabetes,
Department of Pediatrics, Stanford University School of Medicine, Stanford, CA,
USA
- Stanford Diabetes Research Center,
Stanford University School of Medicine, Stanford, CA, USA
- Division of Endocrinology, Gerontology,
& Metabolism, Department of Medicine, Stanford University School of Medicine,
Stanford, CA, USA
| | - Diana Naranjo
- Division of Endocrinology and Diabetes,
Department of Pediatrics, Stanford University School of Medicine, Stanford, CA,
USA
- Stanford Diabetes Research Center,
Stanford University School of Medicine, Stanford, CA, USA
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5
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Silina E, Taube M, Zolovs M. Exploring the Mediating Role of Parental Anxiety in the Link between Children's Mental Health and Glycemic Control in Type 1 Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6849. [PMID: 37835119 PMCID: PMC10572850 DOI: 10.3390/ijerph20196849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023]
Abstract
Pediatric diabetes type 1 diabetes mellitus (T1D), as a chronic, incurable disease, is associated with psychoemotional and socioeconomic burden for the whole family. Disease outcomes are determined by the metabolic compensation of diabetes, characterized by the level of glycated hemoglobin (HbA1c). The caregivers play a critical role in the metabolic control of children with T1D. The aim of this study was to investigate which environmental factors may explain the relationship between diabetes compensation and anxiety and depression of a child. The cross-sectional interdisciplinary study recruited dyads from adolescents and their parents (N = 251). Adolescent and parent groups were screened for anxiety and depression. General linear model (GLM) mediation analysis was performed to determine the potential mediating effect of surrounding factors on the relationship between dependent variables (glycated hemoglobin) and independent variables (the child's anxiety and depression symptoms). The study revealed that the relationship between HbA1c and the child's anxiety and depression is fully mediated (B = 0.366, z = 4.31, p < 0.001) by parental anxiety. Diabetes metabolic control in adolescents with T1D is related to adolescents' mental health via parents' anxiety. This means that parents' anxiety plays a more significant role in the level of HbA1c than the anxiety and depression of the adolescent.
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Affiliation(s)
- Evija Silina
- Department of Psychiatry and Narcology, Riga Stradins University, LV-1007 Riga, Latvia;
| | - Maris Taube
- Department of Psychiatry and Narcology, Riga Stradins University, LV-1007 Riga, Latvia;
| | - Maksims Zolovs
- Statistical Unit, Riga Stradins University, LV-1007 Riga, Latvia;
- Institute of Life Sciences and Technology, Daugavpils University, LV-5401 Daugavpils, Latvia
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Cobry EC, Vigers T, Berget C, Messer LH, Wadwa RP, Pyle L, Forlenza GP. Frequency and Causes of Nocturnal Alarms in Youth and Young Adults With Type 1 Diabetes Using a First-Generation Hybrid Closed-Loop System. Diabetes Spectr 2023; 37:118-123. [PMID: 38756430 PMCID: PMC11093760 DOI: 10.2337/ds23-0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Background Meeting glycemic recommendations is challenging for youth with type 1 diabetes. Diabetes technology, including continuous glucose monitoring (CGM) and hybrid closed-loop (HCL) automated insulin delivery systems, significantly increase achievement of glycemic targets; however, many youth struggle to sustain use of early HCL systems. Nocturnal alarm fatigue contributes to disrupted sleep and device discontinuation. Methods We examined the frequency and causes of nocturnal (10:00 p.m. to 6:00 a.m.) alarms in pediatric patients (N = 76, median age 14.5 years [interquartile range 11.8-17.0 years, range 7-24 years]) starting on a first-generation HCL system in a prospective observational study. Device data were analyzed with linear mixed-effects models to examine change across time at 3-month intervals for 12 months. Results At baseline (HCL system in nonautomated mode), participants averaged 3.3 ± 0.6 alarms per night. In the 2 weeks after starting HCL (automated) mode, alarm frequency significantly increased to 5.4 ± 0.5 times per night (P <0.001). Alarm frequency decreased through the remainder of the observational period; however, CGM sensor and HCL system use also declined. The types of alarms were evenly distributed among sensor maintenance, sensor threshold, pump, and HCL-specific alarms. Conclusion These data show that HCL system nocturnal alarms are frequent and may be barriers to sleep quality and device use. Further research is needed to assess the impact of diabetes technology on sleep and to determine method to improve sleep quality with technology use.
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Affiliation(s)
- Erin C. Cobry
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, CO
| | - Tim Vigers
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, CO
- Colorado School of Public Health, Department of Biostatistics and Informatics, Aurora, CO
| | - Cari Berget
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, CO
| | - Laurel H. Messer
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, CO
| | - R. Paul Wadwa
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, CO
| | - Laura Pyle
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, CO
- Colorado School of Public Health, Department of Biostatistics and Informatics, Aurora, CO
| | - Gregory P. Forlenza
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, CO
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7
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İpar N, Boran P, Barış HE, Us MC, Aygün B, Haliloğlu B, Gökçe T, Can E, Eviz E, İnan NG, Mutlu GY, Bereket A, Hatun Ş. Associations between sleep characteristics and glycemic variability in youth with type 1 diabetes. Sleep Med 2023; 109:132-142. [PMID: 37437493 DOI: 10.1016/j.sleep.2023.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/15/2023] [Accepted: 06/18/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE This study aimed to determine sleep characteristics and their associations with glycemic variability in youth with type 1 diabetes (T1D). MATERIAL AND METHODS This cross-sectional study conducted at two pediatric diabetes centers in Istanbul, Turkey, included 84 children with T1D (mean age 10.5 years). Sleep characteristics and glycemic variability were determined by actigraphy, DSM-5 Level 2-Sleep Disturbance Scale Short Form and continuous glucose monitoring. Circadian preference was evaluated by the Children's Chronotype Questionnaire. Sleep disturbances were assessed by the. The sleep quality was determined by actigraphy-derived sleep measures. RESULTS Eighty-eight percent of participants had insufficient age-appropriate total sleep time (TST) (<9 h for 6-13-year-olds and <8 h for 14-17-year-olds). Chronotype was classified as intermediate in 50%, evening in 45.2%, and morning in 4.8%. A higher chronotype score indicating a stronger eveningness preference was associated with more time spent in hypoglycemia (β = 0.433, p = 0.002). On nights when participants had lower sleep efficiency and longer sleep onset latency, they had significantly higher overnight glycemic variability (β = -0.343, p = 0.016, β = 0.129, p = 0.017, respectively). Prolonged nocturnal wake duration was significantly associated with more time spent in daytime hypoglycemia (β = 0.037, p = 0.046) and higher overnight glycemic variability (J index, β = 0.300, p = 0.015). The associations between TST and glycemic variability indices were not significant. CONCLUSIONS Sleep quality rather than TST was significantly associated with glycemic variability in children with T1D. Eveningness preference might contribute to an increased risk of hypoglycemia. Addressing sleep patterns and chronotypes can be crucial in management plans for youth with T1D.
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Affiliation(s)
- Necla İpar
- Institute of Health Sciences, Social Pediatrics PhD Program, Marmara University, Istanbul, Turkey; Department of Pediatrics, Koc University School of Medicine, Istanbul, Turkey.
| | - Perran Boran
- Institute of Health Sciences, Social Pediatrics PhD Program, Marmara University, Istanbul, Turkey; Department of Pediatrics, Division of Social Pediatrics, Marmara University School of Medicine, Istanbul, Turkey.
| | - Hatice Ezgi Barış
- Institute of Health Sciences, Social Pediatrics PhD Program, Marmara University, Istanbul, Turkey; Department of Pediatrics, Division of Social Pediatrics, Marmara University School of Medicine, Istanbul, Turkey.
| | - Mahmut Caner Us
- Institute of Health Sciences, Social Pediatrics PhD Program, Marmara University, Istanbul, Turkey.
| | - Burcu Aygün
- Institute of Health Sciences, Social Pediatrics PhD Program, Marmara University, Istanbul, Turkey.
| | - Belma Haliloğlu
- Department of Pediatrics, Division of Pediatric Endocrinology, Marmara University School of Medicine, Istanbul, Turkey.
| | - Tuğba Gökçe
- Department of Pediatrics, Division of Pediatric Endocrinology, Koç University School of Medicine, Istanbul, Turkey.
| | - Ecem Can
- Department of Pediatrics, Division of Pediatric Endocrinology, Koç University School of Medicine, Istanbul, Turkey.
| | - Elif Eviz
- Department of Pediatrics, Division of Pediatric Endocrinology, Koç University School of Medicine, Istanbul, Turkey.
| | - Neslihan Gökmen İnan
- College of Engineering, Department of Computer Engineering, Koc University, Istanbul, Turkey.
| | - Gül Yeşiltepe Mutlu
- Department of Pediatrics, Division of Pediatric Endocrinology, Koç University School of Medicine, Istanbul, Turkey.
| | - Abdullah Bereket
- Department of Pediatrics, Division of Pediatric Endocrinology, Marmara University School of Medicine, Istanbul, Turkey.
| | - Şükrü Hatun
- Department of Pediatrics, Division of Pediatric Endocrinology, Koç University School of Medicine, Istanbul, Turkey.
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Marlow AL, King BR, Trost SG, Weaver N, Smart CE. Healthy weight and overweight adolescents with type 1 diabetes mellitus do not meet recommendations for daily physical activity and sleep. Diabetes Res Clin Pract 2023; 203:110879. [PMID: 37591344 DOI: 10.1016/j.diabres.2023.110879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 08/19/2023]
Abstract
AIMS Physical activity (PA) plays an important role in the prevention of cardiovascular disease (CVD), particularly in individuals with type 1 diabetes mellitus (T1DM) who are at increased risk. Our aim was to determine levels of moderate-to-vigorous physical activity (MVPA), sedentary behaviour and sleep in adolescents with T1DM, and identify barriers to PA. METHODS Participants aged 12-18 with T1DM wore an accelerometer and continuous glucose monitor for 24 h over 7-days. Data was processed into PA metrics and sleep. Pearson correlations were used to test associations between MVPA and metabolic measures. Barriers to PA were measured using a questionnaire. RESULTS Thirty-seven adolescents provided valid accelerometer data. Mean daily MVPA was 44.0 min [SD 17.6] with 16.2% achieving the guideline of ≥ 60 min/day. Participants had 11 h [SD 1.2] of sedentary behaviour and 7.6 h [SD 1.5] of sleep/day. There was no difference in MVPA in overweight or obese (53.8%) vs. healthy weight (44.2%) adolescents (45.0 min [SD 16.6] vs. 43.1 min [SD 18.8]). Only 39.6% reported one or more diabetes specific barrier to PA. CONCLUSION Adolescents with T1DM engage in insufficient MVPA and sleep, irrespective of body weight status, suggesting the need for targeted interventions.
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Affiliation(s)
- Alexandra L Marlow
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.
| | - Bruce R King
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia; Department of Paediatric Endocrinology and Diabetes, John Hunter Children's Hospital, New South Wales, Australia.
| | - Stewart G Trost
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Australia; School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia.
| | - Natasha Weaver
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.
| | - Carmel E Smart
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia; Department of Paediatric Endocrinology and Diabetes, John Hunter Children's Hospital, New South Wales, Australia.
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9
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Quattrin T, Mastrandrea LD, Walker LSK. Type 1 diabetes. Lancet 2023; 401:2149-2162. [PMID: 37030316 DOI: 10.1016/s0140-6736(23)00223-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 12/03/2022] [Accepted: 01/26/2023] [Indexed: 04/10/2023]
Abstract
Type 1 diabetes is a chronic disease caused by autoimmune destruction of pancreatic β cells. Individuals with type 1 diabetes are reliant on insulin for survival. Despite enhanced knowledge related to the pathophysiology of the disease, including interactions between genetic, immune, and environmental contributions, and major strides in treatment and management, disease burden remains high. Studies aimed at blocking the immune attack on β cells in people at risk or individuals with very early onset type 1 diabetes show promise in preserving endogenous insulin production. This Seminar will review the field of type 1 diabetes, highlighting recent progress within the past 5 years, challenges to clinical care, and future directions in research, including strategies to prevent, manage, and cure the disease.
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Affiliation(s)
- Teresa Quattrin
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Diabetes Center, John R Oishei Children's Hospital, Buffalo, NY, USA.
| | - Lucy D Mastrandrea
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Diabetes Center, John R Oishei Children's Hospital, Buffalo, NY, USA
| | - Lucy S K Walker
- Institute of Immunity and Transplantation, Division of Infection and Immunity, University College London, London, UK
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10
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Bouman EJ, Beulens JWJ, den Braver NR, Blom MT, Remmelzwaal S, Elders PJM, Rutters F. Social jet lag and (changes in) glycemic and metabolic control in people with type 2 diabetes. Obesity (Silver Spring) 2023; 31:945-954. [PMID: 36855048 DOI: 10.1002/oby.23730] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE Social jet lag, i.e., the discordance among social and biological rhythms, is associated with poor metabolic control. This study aimed to assess cross-sectional and longitudinal associations among social jet lag and glycemic and metabolic control in people with type 2 diabetes. METHODS In a prospective cohort (N = 990) with type 2 diabetes, social jet lag was measured at baseline using daily diaries and was categorized (high, moderate, or low). Metabolic outcomes were assessed at baseline and at 1 and 2 years of follow-up. Associations among social jet lag and glycemic and metabolic control were analyzed using linear regression and linear mixed models adjusted for confounding factors. Analyses were stratified for work status (retired vs. working; p value for interaction = 0.007 for glycated hemoglobin [HbA1c]). RESULTS In working people, a cross-sectional association between high social jet lag and HbA1c (1.87 mmol/mol [95% CI: 0.75 to 2.99]) and blood pressure (5.81 mm Hg [95% CI: 4.04 to 7.59]) was observed. For retired people, high social jet lag was negatively associated with HbA1c (-1.58 mmol/mol [95% CI: -2.54 to -0.62]), glucose (-0.19 mmoL/L [95% CI:-0.36 to -0.01]), and blood pressure (-3.70 mm Hg [95% CI: -5.36 to -2.04]), and the association with BMI was positive (1.12 kg/m2 [95% CI: 0.74 to 1.51]). Prospective associations had the same direction as cross-sectional findings but were nonsignificant for working or retired people. CONCLUSIONS Social jet lag was cross-sectionally, but not prospectively, associated with glycemic and metabolic markers. Interaction with work status was present, and directions of the associations were generally detrimental in the working population, whereas higher social jet lag was associated with improved glycemic and metabolic control for retired people.
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Affiliation(s)
- Emma J Bouman
- Epidemiology and Data Science, Amsterdam UMC Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, the Netherlands
| | - Joline W J Beulens
- Epidemiology and Data Science, Amsterdam UMC Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, the Netherlands
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Nicolette R den Braver
- Epidemiology and Data Science, Amsterdam UMC Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, the Netherlands
| | - Marieke T Blom
- Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, the Netherlands
- Amsterdam UMC Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Sharon Remmelzwaal
- Epidemiology and Data Science, Amsterdam UMC Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, the Netherlands
| | - Petra J M Elders
- Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, the Netherlands
- Amsterdam UMC Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Femke Rutters
- Epidemiology and Data Science, Amsterdam UMC Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, the Netherlands
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11
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Patience M, Janssen X, Kirk A, McCrory S, Russell E, Hodgson W, Crawford M. 24-Hour Movement Behaviours (Physical Activity, Sedentary Behaviour and Sleep) Association with Glycaemic Control and Psychosocial Outcomes in Adolescents with Type 1 Diabetes: A Systematic Review of Quantitative and Qualitative Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4363. [PMID: 36901373 PMCID: PMC10001999 DOI: 10.3390/ijerph20054363] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
Type 1 Diabetes (T1D) is a condition requiring 24-hour management. The way in which an individual combines their 24-hour movement behaviours (24-h MBs), which is comprised of physical activity (PA), sedentary behaviour (SB), and sleep, throughout the day can have a significant impact on physical and mental health. This mixed methods systematic review aimed to investigate 24-h MBs' relationship with glycaemic control and psychosocial outcomes in adolescents (11-18 years) with T1D. Ten databases were searched for quantitative and qualitative English language articles reporting at least one of the behaviours and their relationship with outcomes. There were no restrictions on article publication dates or study design. Articles were subjected to title and abstract screening, full text screening, data extraction and quality assessment. Data were summarised narratively, and a meta-analysis was conducted where possible. From 9922 studies, 84 were included for data extraction (quantitative (n = 76), qualitative (n = 8)). Meta-analyses revealed a significant favourable association between PA and HbA1c (-0.22 [95% CI: -0.35, -0.08; I2 = 92.7%; p = 0.001). SB had an insignificant unfavourable association with HbA1c (0.12 [95% CI: -0.06, 0.28; I2 = 86.1%; p = 0.07]) and sleep had an insignificant favourable association (-0.03 [95% CI: -0.21, 0.15; I2 = 65.9%; p = 0.34]). Importantly, no study investigated how combinations of behaviours collectively interacted and impacted on outcomes.
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Affiliation(s)
- Mhairi Patience
- Psychology Group, Faculty of Humanities & Social Sciences, School of Psychological Sciences & Health, University of Strathclyde, Glasgow G1 1XP, UK
| | - Xanne Janssen
- Physical Activity for Health Group, Faculty of Humanities & Social Sciences, School of Psychological Sciences & Health, University of Strathclyde, Glasgow G1 1XP, UK
| | - Alison Kirk
- Physical Activity for Health Group, Faculty of Humanities & Social Sciences, School of Psychological Sciences & Health, University of Strathclyde, Glasgow G1 1XP, UK
| | - Stephanie McCrory
- Psychology Group, Faculty of Humanities & Social Sciences, School of Psychological Sciences & Health, University of Strathclyde, Glasgow G1 1XP, UK
| | - Eilidh Russell
- Physical Activity for Health Group, Faculty of Humanities & Social Sciences, School of Psychological Sciences & Health, University of Strathclyde, Glasgow G1 1XP, UK
| | - William Hodgson
- Physical Activity for Health Group, Faculty of Humanities & Social Sciences, School of Psychological Sciences & Health, University of Strathclyde, Glasgow G1 1XP, UK
| | - Megan Crawford
- Psychology Group, Faculty of Humanities & Social Sciences, School of Psychological Sciences & Health, University of Strathclyde, Glasgow G1 1XP, UK
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12
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Perfect MM, Silva GE, Chin CN, Wheeler MD, Frye SS, Mullins V, Quan SF. Extending sleep to improve glycemia: The Family Routines Enhancing Adolescent Diabetes by Optimizing Management (FREADOM) randomized clinical trial protocol. Contemp Clin Trials 2023; 124:106929. [PMID: 36441106 DOI: 10.1016/j.cct.2022.106929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 02/06/2023]
Abstract
Sleep deficiencies amongst individuals with type 1 diabetes mellitus (T1DM) have been linked with dysregulated glycemic control and greater morbidities. Sleep extension (EXT) has been identified as a viable intervention target to improve adolescent outcomes. The intervention aims to emphasize collaborative work with families to engage in behaviors that increase the likelihood of the youth increasing their sleep duration consistently. This study will randomize up to 175 youth with T1DM and at least one caregiver to either an EXT intervention or a family routines support (FRS) consultation. It is hypothesized that the EXT condition will lead to improvements in sleep, which in turn, will contribute to improved glycemic control. The primary endpoint is improved glycemic control assessed via a continuous glucose monitor (CGM) to ascertain average glucose levels across a week, glycemic variability, and percent time in the target range at one month and HbA1c at three months. Analyses will control for co-morbid conditions, including sleep-disordered breathing and obesity. This study will provide the needed data to support addressing sleep as part of the standards of care in youth with T1DM.
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Affiliation(s)
- Michelle M Perfect
- Department of Disability and Psychoeducational Studies, College of Education, 1430 E 2nd St., University of Arizona, Tucson, AZ 85721, United States of America.
| | - Graciela E Silva
- College of Nursing, University of Arizona, Tucson, AZ 85721, United States of America
| | - Cindy N Chin
- Pediatrics, Division of Endocrinology, 1501 N. Campbell, Tucson, AZ 85724, United States of America
| | - Mark D Wheeler
- Pediatrics, Division of Endocrinology, 1501 N. Campbell, Tucson, AZ 85724, United States of America
| | - Sara S Frye
- Department of Disability and Psychoeducational Studies, College of Education, 1430 E 2nd St., University of Arizona, Tucson, AZ 85721, United States of America
| | - Vicky Mullins
- Department of Disability and Psychoeducational Studies, College of Education, 1430 E 2nd St., University of Arizona, Tucson, AZ 85721, United States of America
| | - Stuart F Quan
- Asthma and Airway Disease Research Center, University of Arizona College of Medicine, Tucson, AZ 85724, United States of America; Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States of America
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13
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Bouman EJ, Beulens JWJ, Groeneveld L, de Kruijk RS, Schoonmade LJ, Remmelzwaal S, Elders PJM, Rutters F. The association between social jetlag and parameters of metabolic syndrome and type 2 diabetes: a systematic review and meta‐analysis. J Sleep Res 2022; 32:e13770. [PMID: 36351658 DOI: 10.1111/jsr.13770] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 09/20/2022] [Accepted: 09/28/2022] [Indexed: 11/11/2022]
Abstract
This study aims to determine the association between social jetlag and parameters of metabolic syndrome and type 2 diabetes (T2D) in a systematic review and meta-analysis. A systematic literature search was conducted in PubMed/Embase/Scopus until May 2022. Included studies described an association between social jetlag and parameters of the metabolic syndrome and/or T2D, were available full text and written in English or Dutch. Data extraction and quality assessment were performed on pre-piloted forms independently by two reviewers. Results were meta-analysed using random-effects analysis. A total of 6,290 titles/abstracts were screened, 176 papers were read full-text, 68 studies were included. Three studies were rated as low quality, 27 were moderate, and 38 were high quality. High quality studies showed that having social jetlag compared to no social jetlag was significantly associated with higher body mass index in 20 studies (0.49 kg/m2 , 95% confidence interval [CI] 0.21-0.77; I2 = 100%), higher waist circumference in seven studies (1.11 cm, 95% CI 0.42-1.80; I2 = 25%), higher systolic blood pressure in 10 studies (0.37 mmHg, 95% CI 0.00-0.74; I2 = 94%) and higher glycated haemoglobin in 12 studies (0.42%, 95% CI 0.12- 0.72; I2 = 100%). No statistically significant associations were found for obesity, abdominal obesity, high- and low-density lipoprotein levels, cholesterol, triglycerides, diastolic blood pressure, hypertension, fasting glucose, homeostatic model assessment for insulin resistance, metabolic syndrome or T2D. Sensitivity analyses did not reduce heterogeneity. Despite substantial heterogeneity, social jetlag is associated with certain parameters of the metabolic syndrome and T2D, but not with prevalent metabolic syndrome or T2D. These findings should be interpreted with caution as the level of evidence is low and mostly based on cross-sectional data. Longitudinal studies are needed to further assess the direction of causality.
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Affiliation(s)
- Emma J. Bouman
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science Amsterdam Netherlands
- Amsterdam Public Health Health Behaviors & Chronic Diseases Amsterdam The Netherlands
| | - Joline W. J. Beulens
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science Amsterdam Netherlands
- Amsterdam Public Health Health Behaviors & Chronic Diseases Amsterdam The Netherlands
- Julius Centre for Health Sciences and Primary Care University Medical Centre Utrecht Utrecht the Netherlands
| | - Lenka Groeneveld
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science Amsterdam Netherlands
- Amsterdam Public Health Health Behaviors & Chronic Diseases Amsterdam The Netherlands
| | - Rozemarijn S. de Kruijk
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science Amsterdam Netherlands
- Amsterdam Public Health Health Behaviors & Chronic Diseases Amsterdam The Netherlands
| | | | - Sharon Remmelzwaal
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science Amsterdam Netherlands
- Amsterdam Public Health Health Behaviors & Chronic Diseases Amsterdam The Netherlands
| | - Petra J. M. Elders
- Amsterdam Public Health Health Behaviors & Chronic Diseases Amsterdam The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, General Practice Amsterdam Netherlands
| | - Femke Rutters
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science Amsterdam Netherlands
- Amsterdam Public Health Health Behaviors & Chronic Diseases Amsterdam The Netherlands
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14
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Monzon AD, Patton SR, Koren D. Childhood diabetes and sleep. Pediatr Pulmonol 2022; 57:1835-1850. [PMID: 34506691 DOI: 10.1002/ppul.25651] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/18/2021] [Accepted: 08/26/2021] [Indexed: 12/18/2022]
Abstract
Sleep modulates glucose metabolism, both in healthy states and in disease. Alterations in sleep duration (insufficient and excessive) and obstructive sleep apnea may have reciprocal ties with obesity, insulin resistance and Type 2 diabetes, as demonstrated by emerging evidence in children and adolescents. Type 1 diabetes is also associated with sleep disturbances due to the influence of wide glycemic fluctuations upon sleep architecture, the need to treat nocturnal hypoglycemia, and the need for glucose monitoring and insulin delivery technologies. In this article, we provide an extensive and critical review on published pediatric literature regarding these topics, reviewing both epidemiologic and qualitative data, and provide an overview of the pathophysiology linking sleep with disorders of glucose homeostasis.
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Affiliation(s)
- Alexandra D Monzon
- Department of Psychology and Applied Behavioral Science, Clinical Child Psychology Program, University of Kansas, Lawrence, Kansas, USA
| | - Susana R Patton
- Department of Biomedical Research, Center for Healthcare Delivery Science, Nemours Children's Health System, Jacksonville, Florida, USA
| | - Dorit Koren
- Department of Pediatrics, Pediatric Endocrinology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
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15
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Xu Y, Su S, McCall WV, Isales C, Snieder H, Wang X. Rest-activity circadian rhythm and impaired glucose tolerance in adults: an analysis of NHANES 2011-2014. BMJ Open Diabetes Res Care 2022; 10:e002632. [PMID: 35241430 PMCID: PMC8895931 DOI: 10.1136/bmjdrc-2021-002632] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/09/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Circadian rhythm disturbance occurs in type 2 diabetes, yet it is unknown whether it also exists in the prediagnostic phase of the disease. Thus, we examined the association of rest-activity circadian rhythm with 2-hour glucose levels and the risk of impaired glucose tolerance (IGT) in a nationally representative sample of adults without diabetes using a cross-sectional design. RESEARCH DESIGN AND METHODS We analyzed data from 2760 adults without diabetes (age ≥20) with at least 4 days of validated accelerometer recordings and a valid oral glucose tolerance test from the National Health and Nutrition Examination Survey 2011-2014. Non-parametric rest-activity circadian rhythm parameters were derived from the accelerometer recordings. RESULTS In the models adjusting for multiple covariates, a one-quantile increase in relative amplitude (ie, increased circadian rhythmicity) was associated with 2.66 mg/dL decrease in 2-hour glucose level (95% CI -3.94 to -1.38, p<0.001) and a decreased odds of IGT (OR 0.75, 95% CI 0.63 to 0.89, p=0.002). A one-quantile increase in intradaily variability (ie, increased rhythm fragmentation) was associated with 3.01 mg/dL increase in 2-hour glucose level (95% CI 1.52 to 4.49, p=0.001) and an increased odds of IGT (OR 1.37, 95% CI 1.19 to 1.58, p<0.001). CONCLUSIONS Circadian disruption is significantly associated with impaired glucose homeostasis in a general population of adults without diabetes. The association of circadian rhythm abnormalities with indicators of the pre-diabetic state suggests that circadian dysfunction may contribute to early disease pathogenesis.
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Affiliation(s)
- Yanyan Xu
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Shaoyong Su
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - William V McCall
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Carlos Isales
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, Groningen, The Netherlands
| | - Xiaoling Wang
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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16
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Abstract
PURPOSE OF REVIEW To review the relationship between sleep and hypoglycemia, sleep characteristics, and their associations with glycemic control in persons with type 1 diabetes (T1D). The effects of sleep interventions and diabetes technology on sleep are summarized. RECENT FINDINGS Nocturnal hypoglycemia affects objective and subjective sleep quality and is related to behavioral, psychological, and physiological factors. Sleep disturbances are common, including inadequate sleep, impaired sleep efficiency, poor subjective satisfaction, irregular timing, increased daytime sleepiness, and sleep apnea. Some have a bidirectional relationship with glycemic control. Preliminary evidence supports sleep interventions (e.g., sleep extension and sleep coach) in improving sleep and glycemic control, while diabetes technology use could potentially improve sleep. Hypoglycemia and sleep disturbances are common among persons with T1D. There is a need to develop sleep promotion programs and test their effects on sleep, glucose, and related outcomes (e.g., self-care, psychological health).
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Affiliation(s)
- Bingqian Zhu
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Ghada Mohammed Abu Irsheed
- College of Nursing, Department of Biobehavioral Nursing Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Pamela Martyn-Nemeth
- College of Nursing, Department of Biobehavioral Nursing Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Sirimon Reutrakul
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Illinois at Chicago, 835 S. Wolcott Ave, Suite 625E, M/C 640, IL, 60612, Chicago, USA.
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17
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Ji X, Wang Y, Saylor J. Sleep and Type 1 Diabetes Mellitus Management Among Children, Adolescents, and Emerging Young Adults: A Systematic Review. J Pediatr Nurs 2021; 61:245-253. [PMID: 34182231 DOI: 10.1016/j.pedn.2021.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Type 1 diabetes mellitus (T1DM) is one of the most common chronic illnesses among the youth. Emerging evidence has suggested poor sleep as a risk factor for glycemic control. This review aimed to examine the associations between sleep characteristics and diabetes management in children, adolescents, and emerging young adults with T1DM. METHODS Following PRISMA guidelines, the authors searched articles in PubMed, Web of Science, and Scopus from 2000 through August 2020. Using inclusion and exclusion criteria, observational studies and clinical trials that examined sleep and diabetes management among individuals with T1DM (up to 25 years old) were selected for review. RESULTS Twenty-four articles met the review criteria. Most studies did not report differences in self-report sleep between individuals with and without T1DM. However, several studies using objective sleep measures (actigraph and PSG) suggested shorter sleep duration and worse sleep quality in individuals with T1DM. Higher A1C levels and undesirable T1DM self-care behaviors were associated with short and long sleep duration, poor sleep quality, sleep disturbances, and irregular sleep, particularly among adolescent boys, young men and those from immigrant families. Self-care behaviors mediated the associations between sleep and subsequent A1C levels. CONCLUSIONS Too much or too little sleep, poor sleep quality, sleep disturbances and sleep variability are associated with undesirable T1DM management. Although more research is needed, our findings indicate the importance of including sleep education in the plan of care for children, adolescents and emerging young adults with T1DM.
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Affiliation(s)
- Xiaopeng Ji
- College of Health Sciences, School of Nursing, University of Delaware, DE, USA.
| | - Yiqi Wang
- College of Health Sciences, School of Nursing, University of Delaware, DE, USA; University of Pennsylvania School of Nursing, PA, USA.
| | - Jennifer Saylor
- College of Health Sciences, School of Nursing, University of Delaware, DE, USA.
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18
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Silva RAE, Ganen ADP, Fernandes VDFT, Evangelista NMDA, Figueiredo CC, Pacheco LDA, Colares Neto GDP. Evaluation of sleep characteristics of children and adolescents with type 1 diabetes mellitus. REVISTA PAULISTA DE PEDIATRIA 2021; 40:e2020407. [PMID: 34614139 PMCID: PMC8543827 DOI: 10.1590/1984-0462/2022/40/2020407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/14/2021] [Indexed: 12/02/2022]
Abstract
Objective: To evaluate sleep characteristics of children and adolescents with type 1 diabetes mellitus (T1DM) and their relationship with glycemic control. Methods: A cross-sectional study was conducted at a public hospital in São Paulo, Brazil. It included 86 patients with T1DM, aged between 10 and 18 years old, who were on insulin therapy, had performed at least three measurements of capillary blood glucose throughout the day, and had normal thyroid function. The clinical, anthropometric, and laboratory data of each patient were evaluated. The Pediatric Daytime Sleepiness Scale (PDSS) and the Munich Chronotype Questionnaire (MCTQ) were used to assess the sleep characteristics. Results: The mean level of glycated hemoglobin (HbA1c) was 9.2±2.1%, and it was higher in adolescents than in children. The mean score of PDSS was 13.9±4.7. Patients with HbA1c<7.5% had lower PDSS scores and longer sleep duration on weekdays than patients with HbA1c≥7.5%. HbA1c levels were negatively correlated with chronotype values and sleep duration on weekdays and positively correlated with social jet lag. Patients who had had T1DM for less than three years had a higher prevalence of daytime sleepiness. The regression analysis showed that higher HbA1c (≥7.5%) and shorter time since the diagnosis of T1DM increased the chance of daytime sleepiness, regardless of age and sex. Conclusions: Patients with higher HbA1c had more daytime sleepiness, a morning chronotype, shorter sleep duration on weekdays and a more significant social jet lag. The shorter diagnosis time for T1DM and greater levels of HbA1c increased the chance of daytime sleepiness.
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19
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Rose S, Boucher SE, Galland BC, Wiltshire EJ, Stanley J, Smith C, de Bock MI, Rayns JA, MacKenzie KE, Wheeler BJ. Impact of high-risk glycemic control on habitual sleep patterns and sleep quality among youth (13-20 years) with type 1 diabetes mellitus compared to controls without diabetes. Pediatr Diabetes 2021; 22:823-831. [PMID: 33880853 DOI: 10.1111/pedi.13215] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 03/28/2021] [Accepted: 04/06/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND In type 1 diabetes mellitus (T1D), glycemic control and sleep have a bidirectional relationship, with unhealthy glycemic control impacting sleep, and inadequate sleep impacting diabetes management. Youth are at risk for poor quality sleep; however, little is known about sleep among youth with high-risk glycemic control. OBJECTIVE To assess differences in habitual sleep timing, duration, and quality among youth with T1D and controls. SUBJECTS Two-hundred-thirty youth (13-20 years): 64 with T1D (mean age 16.6 ± 2.1 years, 48% female, diabetes duration 7.5 ± 3.8 years, HbA1c 96 ± 18.0 mmol/mol [10.9 ± 1.7%]), and 166 controls (mean age 15.3 ± 1.5, 58% female). METHODS Comparison of data from two concurrent studies (from the same community) using subjective and objective methods to assess sleep in youth: Pittsburgh Sleep Quality Index evaluating sleep timing and quality; 7-day actigraphy measuring habitual sleep patterns. Regression analyses were used to compare groups. RESULTS When adjusted for various confounding factors, youth with T1D reported later bedtimes (+36 min; p < 0.05) and shorter sleep duration (-53 min; p < 0.05) than controls, and were more likely to rate subjective sleep duration (OR 3.57; 95% CI 1.41-9.01), efficiency (OR 4.03; 95% CI 1.43-11.40), and quality (OR 2.59; 95% CI 1.16-5.76) as "poor" (p < 0.05). However, objectively measured sleep patterns were similar between the two groups. CONCLUSIONS Youth with high-risk T1D experience sleep difficulties, with later bedtimes contributing to sleep deficit. Despite a lack of objective differences, they perceive their sleep quality to be worse than peers without diabetes.
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Affiliation(s)
- Shelley Rose
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.,Department of Pediatrics and Child Health, University of Otago Wellington, Wellington, New Zealand
| | - Sara E Boucher
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Barbara C Galland
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Esko J Wiltshire
- Department of Pediatrics and Child Health, University of Otago Wellington, Wellington, New Zealand.,Pediatric Department, Capital and Coast District Health Board, Wellington, New Zealand
| | - James Stanley
- Biostatistical Group, Dean's Department, University of Otago Wellington, Wellington, New Zealand
| | - Claire Smith
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Martin I de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand.,Pediatric Department, Canterbury District Health Board, Christchurch, New Zealand
| | - Jenny A Rayns
- Endocrinology Department, Southern District Health Board, Dunedin, New Zealand
| | - Karen E MacKenzie
- Department of Paediatrics, University of Otago, Christchurch, New Zealand.,Pediatric Department, Canterbury District Health Board, Christchurch, New Zealand
| | - Benjamin J Wheeler
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.,Pediatric Department, Southern District Health Board, Dunedin, New Zealand
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20
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Ray MK, McMichael A, Rivera-Santana M, Noel J, Hershey T. Technological Ecological Momentary Assessment Tools to Study Type 1 Diabetes in Youth: Viewpoint of Methodologies. JMIR Diabetes 2021; 6:e27027. [PMID: 34081017 PMCID: PMC8212634 DOI: 10.2196/27027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/26/2021] [Accepted: 04/03/2021] [Indexed: 11/13/2022] Open
Abstract
Type 1 diabetes (T1D) is one of the most common chronic childhood diseases, and its prevalence is rapidly increasing. The management of glucose in T1D is challenging, as youth must consider a myriad of factors when making diabetes care decisions. This task often leads to significant hyperglycemia, hypoglycemia, and glucose variability throughout the day, which have been associated with short- and long-term medical complications. At present, most of what is known about each of these complications and the health behaviors that may lead to them have been uncovered in the clinical setting or in laboratory-based research. However, the tools often used in these settings are limited in their ability to capture the dynamic behaviors, feelings, and physiological changes associated with T1D that fluctuate from moment to moment throughout the day. A better understanding of T1D in daily life could potentially aid in the development of interventions to improve diabetes care and mitigate the negative medical consequences associated with it. Therefore, there is a need to measure repeated, real-time, and real-world features of this disease in youth. This approach is known as ecological momentary assessment (EMA), and it has considerable advantages to in-lab research. Thus, this viewpoint aims to describe EMA tools that have been used to collect data in the daily lives of youth with T1D and discuss studies that explored the nuances of T1D in daily life using these methods. This viewpoint focuses on the following EMA methods: continuous glucose monitoring, actigraphy, ambulatory blood pressure monitoring, personal digital assistants, smartphones, and phone-based systems. The viewpoint also discusses the benefits of using EMA methods to collect important data that might not otherwise be collected in the laboratory and the limitations of each tool, future directions of the field, and possible clinical implications for their use.
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Affiliation(s)
- Mary Katherine Ray
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States
| | - Alana McMichael
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States
| | - Maria Rivera-Santana
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States
| | - Jacob Noel
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States
| | - Tamara Hershey
- Department of Psychiatry, Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, United States
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21
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Macaulay GC, Galland BC, Boucher SE, Wiltshire EJ, Haszard JJ, Campbell AJ, Black SM, Smith C, Elder D, Wheeler BJ. Impact of type 1 diabetes mellitus, glucose levels, and glycemic control on sleep in children and adolescents: a case-control study. Sleep 2021; 43:5580781. [PMID: 31583407 DOI: 10.1093/sleep/zsz226] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 07/03/2019] [Indexed: 12/13/2022] Open
Abstract
STUDY OBJECTIVES To assess differences in habitual sleep patterns and sleep states between children and adolescents with type 1 diabetes mellitus (T1DM) and control subjects, and to explore the relationships between sleep, glucose levels, and glycemic control. METHODS Participants included 82 children (5-18 years); 41 with T1DM (cases), and 41 healthy control subjects group matched for age and sex. Sleep was measured by 7-day actigraphy and single-night home-based polysomnography (PSG) recordings. Hemoglobin A1c (HbA1c) and 7 days of continuous glucose monitoring (CGM) data were collected in cases. Regression analyses were used to model all within- and between-group comparisons adjusted for age, sex, and BMI z-scores. RESULTS There were no significant differences in sleep duration, efficiency, or awakenings as measured by actigraphy and PSG between cases and controls, nor sleep states measured by PSG. However, cases had significantly later sleep onset and offset than controls (both p < 0.05), partially moderated by age. Cases with suboptimal glycemic control (HbA1c ≥ 58 mmol/mol [≥7.5%]) had significantly shorter actigraphy-derived total sleep time (TST) (mean difference = -40 minutes; 95% confidence interval = -77, -3), with similar differences in TST measured by PSG. Cases with mean CGM glucose levels ≥10 mmol/L (≥180 mg/dL) on PSG night had significantly more stage N3 (%) sleep and less stage REM (%) sleep (both p < 0.05). CONCLUSIONS Short- and long-term suboptimal glycemic control in T1DM children appears to be associated with sleep alterations. Pediatric diabetes care teams should be aware of potential interrelationships between sleep and T1DM, including management and glycemic control.
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Affiliation(s)
- Grace C Macaulay
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Barbara C Galland
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Sara E Boucher
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Esko J Wiltshire
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Jillian J Haszard
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Angela J Campbell
- WellSleep Investigation Centre, Department of Medicine, University of Otago, Wellington, New Zealand and
| | - Stephanie M Black
- WellSleep Investigation Centre, Department of Medicine, University of Otago, Wellington, New Zealand and
| | - Claire Smith
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Dawn Elder
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Benjamin J Wheeler
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand.,Paediatric Endocrinology, Southern District Health Board, Dunedin, New Zealand
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22
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Wu IH, Heredia N, Dong Q, McNeill LH, Balachandran DD, Lu Q, Chang S. Sleep duration and type 2 diabetes risk: A prospective study in a population-based Mexican American cohort. Sleep Health 2021; 7:168-176. [PMID: 33582048 DOI: 10.1016/j.sleh.2020.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 12/03/2020] [Accepted: 12/09/2020] [Indexed: 12/20/2022]
Abstract
STUDY OBJECTIVES The primary aim of the study was to estimate the effect of sleep duration on prospective type 2 diabetes (T2D) risk across demographic characteristics and follow-up periods, and test body mass index (BMI) as a mediator and moderator. METHODS Data included adults (Mage = 39.0 ± 12.7 years) born in the United States or Mexico recruited from 2001 to 2012 in a Mexican American cohort study conducted in Houston, TX (n = 15,779). Participants completed self-reported questionnaires at baseline related to health, health behaviors (sleep duration, physical activity, smoking, drinking), and sociocultural factors and were followed up annually. RESULTS Cox proportional hazard models estimated hazard ratios (HR) for the effect of sleep duration on T2D diagnosis at follow-up. Of the participants, 10.3% were diagnosed with T2D. Self-reported ≤5 hours of sleep, compared to 7-8 hours, at baseline predicted greater risk for T2D (HR = 1.32, P = .001), yet was no longer significant after adjusting for sociodemographic characteristics and BMI. Notably, those with BMI <25 kg/m2 reporting ≤5 hours of sleep were at significant risk for T2D at 3 (HR = 4.13, P = .024) and 5-year follow-up (HR = 3.73, P = .008) compared to 7-8 hours. Obesity status accounted for 31.6% and 27.3% of the variance in the association between ≤5 and 6 hours of sleep and increased T2D risk, respectively. CONCLUSIONS Results highlighted the mediating and moderating role of BMI, and its effect on T2D risk at earlier follow-up among those without obesity. T2D prevention and control for Mexican American adults should consider the role of chronic sleep loss.
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Affiliation(s)
- Ivan Hc Wu
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Natalia Heredia
- Department of Health Promotion & Behavioral Sciences, The University of Texas Health Science Center at Houston, School of Public Health, Houston, Texas, USA
| | - Qiong Dong
- Department of Epidemiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lorna H McNeill
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diwakar D Balachandran
- Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Qian Lu
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shine Chang
- Department of Epidemiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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23
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Aragona M, Rodia C, Bertolotto A, Campi F, Coppelli A, Giannarelli R, Bianchi C, Dardano A, Del Prato S. Type 1 diabetes and COVID-19: The "lockdown effect". Diabetes Res Clin Pract 2020; 170:108468. [PMID: 32987040 PMCID: PMC7518840 DOI: 10.1016/j.diabres.2020.108468] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/15/2020] [Accepted: 09/18/2020] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to evaluate the effect the lockdown imposed during COVID-19 outbreak on the glycemic control of people with Type 1 diabetes (T1D) using Continuous (CGM) or Flash Glucose Monitoring (FGM). MATERIALS AND METHODS We retrospectively analyzed glucose reading obtained by FGM or CGM in T1D subjects. Sensor data from 2 weeks before the lockdown (Period 0, P0), 2 weeks immediately after the lockdown (period 1, P1), in mid-lockdown (Period 2, P2) and immediately after end of lockdown (Period 3, P3) were analyzed. RESULTS The study included 63 T1D patients, (FGM: 52, 82%; CGM:11, 18%). Sensor use (91%) were slightly reduced. Despite this reduction, Time in Range increased in P1 (62%), P2 (61%) and P3 (62%) as compared to P0 (58%, all p < 0.05 or less) with concomitant reduction in the Time Above Range (P0: 38%; P1: 34%, P2: 34%, P3: 32%, all p < 0.05 or less vs. P0). Average glucose and GMI improved achieving statistical difference in P3 (165 vs. 158 mg/dl, p = 0.040 and 7.2% (55 mmol/mol) vs. 7.0% (53 mmol/mol), p = 0.016) compared to P0. Time Below Range (TBR) and overall glucose variability remained unchanged. Bi-hourly analysis of glucose profile showed an improvement particularly in the early morning hours. CONCLUSIONS In T1D subjects with good glycemic control on CGM or FGM, the lockdown had no negative impact. Rather a modest but significant improvement in glycemic control has been recorded, most likely reflecting more regular daily life activities and reduces work-related distress.
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Affiliation(s)
- Michele Aragona
- Section of Metabolic Diseases & Diabetes, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Cosimo Rodia
- Section of Endocrinology & Metabolic Diseases, ASL Brindisi, DSS-1, Brindisi, Italy
| | - Alessandra Bertolotto
- Section of Metabolic Diseases & Diabetes, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Fabrizio Campi
- Section of Metabolic Diseases & Diabetes, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Alberto Coppelli
- Section of Metabolic Diseases & Diabetes, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Rosa Giannarelli
- Section of Metabolic Diseases & Diabetes, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Cristina Bianchi
- Section of Metabolic Diseases & Diabetes, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Angela Dardano
- Section of Metabolic Diseases & Diabetes, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Del Prato
- Section of Metabolic Diseases & Diabetes, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy.
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24
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Jaser SS, Hamburger ER, Bergner EM, Williams R, Slaughter JC, Simmons JH, Malow BA. Sleep coach intervention for teens with type 1 diabetes: Randomized pilot study. Pediatr Diabetes 2020; 21:473-478. [PMID: 32003520 PMCID: PMC7670490 DOI: 10.1111/pedi.12991] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/21/2020] [Accepted: 01/24/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Teens with type 1 diabetes (T1D) experience increased sleep disturbances, which have been linked to problems with adherence and glycemic control. As such, sleep represents a novel target to improve outcomes in teens. OBJECTIVE To evaluate the feasibility, acceptability, and preliminary efficacy of a sleep-promoting intervention in teens with T1D. RESEARCH DESIGN AND METHODS Teens aged 13 to 17 with T1D (n = 39) completed measures of sleep quality and diabetes management and wore actigraphs to obtain an objective measure of sleep. Hemoglobin A1C (HbA1c) was collected from medical records. Teens were randomized to Usual Care (n = 19) or the Sleep Coach intervention (n = 20). Teens in the Sleep Coach group received educational materials on healthy sleep habits and completed three individual telephone sessions. Follow-up data were collected at 3 months, including exit interviews with teens and parents. RESULTS Feasibility of the study was excellent; 80% of teens in the Sleep Coach group completed all three sessions, and retention was high (90%). Based on actigraphy data, a significant improvement in sleep efficiency and sleep duration was observed (48-minute increase) among teens randomized to the Sleep Coach intervention, and teens in the control group were 7.5 times more likely to report poor sleep quality after 3 months than intervention participants. No change in HbA1c was observed. CONCLUSIONS The Sleep Coach intervention for teens with T1D is a feasible and acceptable program that increased sleep duration and improved sleep quality for this high-risk population.
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Affiliation(s)
- Sarah S. Jaser
- Department of PediatricsVanderbilt University Medical Center Nashville Tennessee
| | - Emily R. Hamburger
- Department of PediatricsVanderbilt University Medical Center Nashville Tennessee
| | - Erin M. Bergner
- Department of PediatricsVanderbilt University Medical Center Nashville Tennessee
| | - Rodayne Williams
- Department of PediatricsVanderbilt University Medical Center Nashville Tennessee
| | - James C. Slaughter
- Department of PediatricsVanderbilt University Medical Center Nashville Tennessee
| | - Jill H. Simmons
- Department of PediatricsVanderbilt University Medical Center Nashville Tennessee
| | - Beth A. Malow
- Department of PediatricsVanderbilt University Medical Center Nashville Tennessee
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25
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Nefs GM, Bazelmans E, Donga E, Tack CJ, de Galan BE. Sweet dreams or bitter nightmare: a narrative review of 25 years of research on the role of sleep in diabetes and the contributions of behavioural science. Diabet Med 2020; 37:418-426. [PMID: 31833083 DOI: 10.1111/dme.14211] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2019] [Indexed: 12/12/2022]
Abstract
The aim of this review was to provide an overview of developments, clinical implications and gaps in knowledge regarding the relationship between diabetes and sleep over the past 25 years, with special focus on contributions from the behavioural sciences. Multiple prospective observational and experimental studies have shown a link between suboptimal sleep and impaired glucose tolerance, decreased insulin sensitivity and the development of type 2 diabetes. While prevalence rates of suboptimal sleep vary widely according to definition, assessment and sample, suboptimal subjective sleep quality appears to be a common reality for one-third of people with type 1 diabetes and over half of people with type 2 diabetes. Both physiological and psychosocial factors may impair sleep in these groups. In turn, suboptimal sleep can negatively affect glycaemic outcomes directly or indirectly via suboptimal daytime functioning (energy, mood, cognition) and self-care behaviours. Technological devices supporting diabetes self-care may have both negative and positive effects. Diabetes and its treatment also affect the sleep of significant others. Research on the merits of interventions aimed at improving sleep for people with diabetes is in its infancy. Diabetes and sleep appear to be reciprocally related. Discussion of sleep deserves a central place in regular diabetes care. Multi-day, multi-method studies may shed more light on the complex relationship between sleep and diabetes at an individual level. Intervention studies are warranted to examine the potential of sleep interventions in improving outcomes for people with diabetes.
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MESH Headings
- Behavioral Sciences/history
- Behavioral Sciences/methods
- Behavioral Sciences/trends
- Blood Glucose/physiology
- Diabetes Mellitus/blood
- Diabetes Mellitus/etiology
- Diabetes Mellitus/physiopathology
- Diabetes Mellitus/psychology
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/epidemiology
- Diabetes Mellitus, Type 1/physiopathology
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/physiopathology
- History, 20th Century
- History, 21st Century
- Humans
- Prevalence
- Sleep/physiology
- Sleep Wake Disorders/complications
- Sleep Wake Disorders/epidemiology
- Time Factors
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Affiliation(s)
- G M Nefs
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Centre of Research on Psychological and Somatic Disorders (CoRPS), Tilburg, The Netherlands
- Diabeter, National Treatment and Research Centre for Children, Adolescents and Young Adults with Type 1 Diabetes, Rotterdam, The Netherlands
| | - E Bazelmans
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - E Donga
- Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - C J Tack
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - B E de Galan
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Internal Medicine, Maastricht UMC+, Maastricht, The Netherlands
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26
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Li A, Chen S, Quan SF, Silva GE, Ackerman C, Powers LS, Roveda JM, Perfect MM. Sleep patterns and sleep deprivation recorded by actigraphy in 4th-grade and 5th-grade students. Sleep Med 2019; 67:191-199. [PMID: 31935621 DOI: 10.1016/j.sleep.2019.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/30/2019] [Accepted: 12/02/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study investigates sleep patterns of fourth- and fifth-grade students using actigraphy. METHODS The study included 257 students enrolled in a Southwestern US school district who participated in a novel sleep science curriculum during the Spring 2016-17 and Fall 2017-18 semesters and met the study inclusion criteria. As part of this curriculum, participants underwent 5-7 days of continuous wrist actigraphy and completed an online sleep diary. RESULTS Approximately two-thirds of the 9-11-year-old fourth- and fifth-grade students slept less than the minimum 9 h per night recommended by both the American Academy of Sleep Medicine/Sleep Research Society and the National Sleep Foundation. The sleep midpoint time on weekends was about 1 h later than on weekdays. There was a significant effect of age on sleep duration. Compared to 9-year old students, a larger proportion of 10-year old students had a sleep duration less than 8.5 h. Boys had shorter sleep duration than girls, and a larger percentage of boys obtained less than 9 h of sleep compared to girls. CONCLUSIONS Insufficient sleep is a highly prevalent condition among 9-11-year-old fourth- and fifth-grade elementary students. Importantly, there is a difference between sleep patterns on weekdays and weekends which may portend greater problems with sleep in adolescence and young adulthood.
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Affiliation(s)
- Ao Li
- Department of Electrical and Computer Engineering, College of Engineering, University of Arizona, Tucson, AZ, USA.
| | - Siteng Chen
- Department of Electrical and Computer Engineering, College of Engineering, University of Arizona, Tucson, AZ, USA
| | - Stuart F Quan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Asthma and Airway Disease Research Center, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Graciela E Silva
- Biobehavioral Health Science Division, College of Nursing, University of Arizona, Tucson, AZ, USA
| | | | - Linda S Powers
- Department of Electrical and Computer Engineering, College of Engineering, University of Arizona, Tucson, AZ, USA; Department of Biomedical Engineering, College of Engineering, University of Arizona, Tucson, AZ, USA
| | - Janet M Roveda
- Department of Electrical and Computer Engineering, College of Engineering, University of Arizona, Tucson, AZ, USA; Department of Biomedical Engineering, College of Engineering, University of Arizona, Tucson, AZ, USA
| | - Michelle M Perfect
- Disability and Psychoeducational Studies, College of Education, University of Arizona, Tucson, AZ, USA
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