Variations in Sleep Characteristics and Glucose Regulation in Young Adults with Type 1 Diabetes

Abstract Context Short sleep duration and sleep disruptions are associated with impaired glucoregulation in type 1 diabetes (T1D). However, the mechanistic pathways between sleep and glucose variability remain unclear. Objective To determine within-and between-person associations between objective sleep-wake characteristics and glucose variability indices. Design/Setting Multilevel models (MLMs) were used to analyze concurrent sleep and glucose patterns over seven days in 42 young adults with T1D in their natural home environment. Patients or Other Participants Young adults with T1D (mean age of 22.2 ± 3.0 years, HbA1C 7.2%, 32.6% male) for at least 6 months with no other medical or major psychiatric comorbidity were included. Main Outcome Measure(s) Sleep-wake characteristics via wrist actigraphy and glucose variability indices via a continuous glucose monitor (CGM). Results Lower sleep efficiency predicted higher glucose variability (less time in range β= .011 and more time in hyperglycemia β= -.011) within-person. A longer wake after sleep onset and more sleep disruptions were associated with higher glucose variability between persons (β= .28 - .31). Higher glucose variability predicted poorer sleep within-person (delayed bedtime, waketime, mid-sleep time, and lower sleep efficiency), while higher glucose variability was associated with poorer sleep and more sleep disruptions between persons (lower sleep efficiency, longer wake after sleep onset, and a higher sleep fragmentation index). Conclusions Clinicians can address the reciprocal nature of the sleep-glucose relationship by optimizing sleep and targeting efforts towards a euglycemic range overnight. Sleep habits are a modifiable personal target in diabetes care.

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0927 Variations in Sleep and Glucose in Adolescents with Type 1 Diabetes

SLEEP ◽

10.1093/sleep/zsaa056.923 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A352-A353

Author(s):

S Griggs ◽

N S Redeker ◽

S Jeon ◽

M Grey

Keyword(s):

Type 1 Diabetes ◽

Blood Glucose ◽

Sleep Duration ◽

Sleep Onset ◽

Glucose Variability ◽

Poor Sleep ◽

Short Sleep Duration ◽

High Blood Glucose ◽

Short Sleep

Abstract Introduction The association between short sleep duration and poorer glycemic control in adolescents ages 10-16 with type 1 diabetes (T1D) is well established. Researchers have used cross-sectional, between-subjects’ methods, with limited focus on the potential intraindividual variation among these variables. The purpose of this analysis was to examine the within person associations between glucose variability indices (J index, low/high blood glucose index, time in range) and sleep characteristics (bedtime, waketime, total sleep time, sleep efficiency, wake after sleep onset [WASO], awakenings, and sleep fragmentation index) in adolescents with T1D. Methods Adolescents monitored their sleep and glucose patterns concurrently for 3-7 days with a wrist actigraph on their non-dominant wrist and either their own continuous glucose monitor (CGM) or a provided blinded CGM. General linear mixed models (GLMM) were used to determine within-person and day level associations. Results The sample included 38 adolescents (M age 13.4±1.8; 37.8% male; M A1C 8.2±1.2%). Average glucose levels were controlled in all GLMMs. Adolescents had earlier waketimes on days when more time was spent in hypoglycemia <70mg/dL (β=-0.15, p<0.001). At the person level, adolescents had greater WASO with more % time spent in severe hypoglycemia <54mg/dL with more severe low blood glucose indices (β=0.35, p<0.01 and β=0.34, p<0.01 respectively). At the daily level, adolescents had greater WASO (β=0.20, p=0.01) and more awakenings (β=0.16, p=0.04) on the days they had more overall glucose variability (J index) and more severe high blood glucose indices (β=0.17, p=0.04), but were less likely to have more % time in hypoglycemia (β=-0.15, p=0.02). Conclusion Glucose variability was positively associated with poor sleep (e.g., WASO and awakenings) in adolescents with T1D both at the daily and intraindividual level. Monitoring over a longer period of time in subsequent studies would allow researchers to determine the within person associations between habitual short sleep duration and glucose variability. Support NINR T32NR0008346 & P20NR014126, Medtronic MiniMed provided CGMs at a discounted rate for the study.

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1020 Sleep and Glycemic Control in Adults With Long-Standing Type 1 Diabetes and Hypoglycemia Unawareness

SLEEP ◽

10.1093/sleep/zsaa056.1016 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A387-A388

Author(s):

S K Malone ◽

A J Peleckis ◽

A I Pack ◽

N Perez ◽

G Yu ◽

...

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Sleep Onset ◽

Glucose Monitoring ◽

Glycemic Variability ◽

Sleep Efficiency ◽

Hypoglycemia Unawareness ◽

Time In Bed ◽

Hba1c Levels

Abstract Introduction Nocturnal hypoglycemia is life threatening for individuals with type 1 diabetes (T1D) due to loss of hypoglycemia symptom recognition (hypoglycemia unawareness) and impaired glucose counterregulation. These individuals also show disturbed sleep, which may result from glycemic dysregulation. Whether use of a hybrid closed loop (HCL) insulin delivery system with integrated continuous glucose monitoring (CGM) designed for improving glycemic control, relates to better sleep across time in this population remains unknown. Methods Six adults (median age=58y,T1D duration=41y) participated in an 18-month ongoing clinical trial assessing the effectiveness of an HCL system. Sleep and glycemic control were measured concurrently using wrist actigraphs and CGM at baseline (1 week) and months 3 and 6 (3 weeks) following HCL initiation. BMI and hemoglobin A1c (HbA1c) were collected at all timepoints. Spearman’s correlations modeled associations between sleep, BMI, and glycemic control at each time point. Repeated ANOVAs modeled sleep and glycemic control changes from baseline to 3 months and to 6 months. Results Sleep and glycemic control indices showed significant associations at baseline and 3 months. More time-in-bed and later sleep offset related to higher HbA1c levels at baseline. Later sleep onset, midpoint and offset, and greater sleep efficiency associated with greater %time with hyperglycemia (glucose >180 mg/dL) or hypoglycemia (glucose <70 mg/dL) at baseline and 3 months. Longer sleep duration and greater sleep efficiency related to greater %time with hyperglycemia at 3 months. At 3 months, more wake after sleep onset associated with lower HbA1c levels and longer nocturnal awakenings and more sleep fragmentation associated with less glycemic variability. While both sleep and glycemic control improved from baseline to 3 and 6 months, these were not statistically significant. Conclusion Various dimensions of actigraphic sleep related to concurrently estimated glycemic indices indicative of poorer glycemic control and HbA1c across time in adults with long-standing T1D and hypoglycemia unawareness. Support This work was supported by NIH R01DK117488 (NG), R01DK091331 (MRR), and K99NR017416 (SKM).

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643 Rest Activity Rhythms, Symptom Burden, and Glucose Variability in Young Adults with Type 1 Diabetes

SLEEP ◽

10.1093/sleep/zsab072.641 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A252-A252

Author(s):

Stephanie Griggs ◽

Kingman Strohl ◽

Seunghee Margevicius ◽

Margaret Grey ◽

Ronald Hickman

Keyword(s):

Type 1 Diabetes ◽

Young Adults ◽

Daytime Sleepiness ◽

Activity Rhythm ◽

Symptom Burden ◽

Glucose Variability ◽

Diabetes Distress ◽

Distress Scale ◽

Rest Activity

Abstract Introduction Circadian alignment is an important element in individual health, and one behavioral marker, rest-activity rhythm (RAR), may influence disease management in young adults with type 1 diabetes (T1D). Thus, in this descriptive study, we examined whether circadian rhythm is correlated with symptoms (emotional and diabetes distress, and diabetes physical symptom burden) and glucose variability in young adults with T1D. Methods Using convenience sampling, young adults with T1D underwent concurrent actigraphy and continuous glucose monitoring for 6–14 days to generate the following RAR parameters: (MESOR, amplitude, acrophase, and circadian quotient) and glucose variability indices (coefficient of variation and time in range). Participants completed the 8-item Epworth Sleepiness Scale, 8-item PROMIS v1.0 Emotional Distress Scale, 17-item Diabetes Distress Scale, and 34-item Diabetes Symptom Checklist-Revised. Cosinor analysis was used to compute the RAR parameters and linear regression modeling procedures were performed to determine the associations among the study variables. Results The sample included 46 young adults (mean age 22.3±3.2; 32.6% male; 84.8% non-Hispanic White, A1C mean 7.2±1.1%, BMI 27.0±4.4 kg/m2). A more robust rhythm (higher amplitude) was associated with a lower diabetes symptom burden (ß=-0.31, p=.035). A higher circadian quotient was associated with less daytime sleepiness (ß=-0.41, p=.004). All associations between the RAR parameters and symptom measures remained statistically significant (p<.05) after adjustment for sex and BMI. The associations between the RAR parameters and glucose variability indices were not significant. Conclusion RAR was associated with daytime sleepiness, as well as symptom burden in young adults with T1D even after consideration of sex and BMI. Future investigators should clarify the causality of these associations and the potential for improving the strength and stability of RAR in the mitigation of daytime sleepiness and symptoms. Support (if any) This research is or was partially supported by grants from the American Academy of Sleep Medicine (220-BS-19), National Institute of Nursing Research (K99NR018886 & T32NR0008346), Sigma Theta Tau International, and Dexcom provided continuous glucose monitors (G4) free of charge for participants who did not have a device.

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The Effects of Subcutaneous Insulin Infusion Versus Multiple Insulin Injections on Glucose Variability in Young Adults with Type 1 Diabetes: The 2-Year Follow-Up of the Observational METRO Study

Diabetes Technology & Therapeutics ◽

10.1089/dia.2017.0334 ◽

2018 ◽

Vol 20 (2) ◽

pp. 117-126 ◽

Cited By ~ 13

Author(s):

Maria Ida Maiorino ◽

Giuseppe Bellastella ◽

Ofelia Casciano ◽

Paolo Cirillo ◽

Vittorio Simeon ◽

...

Keyword(s):

Type 1 Diabetes ◽

Young Adults ◽

Insulin Infusion ◽

Glucose Variability ◽

Subcutaneous Insulin

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1005 Characterizing Sleep and Glycemia in Emerging Adults with Type 1 Diabetes

SLEEP ◽

10.1093/sleep/zsaa056.1001 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A382-A382

Author(s):

S Griggs ◽

N S Redeker ◽

M Grey

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Emerging Adults ◽

Sleep Onset ◽

Glucose Variability ◽

High Risk Population ◽

Sleep Onset Latency ◽

True Nature ◽

Psychomotor Vigilance

Abstract Introduction Type 1 Diabetes (T1D) affects 1.25 million Americans, and only 14% of emerging adults (ages 18-30 years) achieve targets for glycemic control (A1C < 7.0%). Sleep deficiency, less than 6.5 hours total sleep time (TST), is associated with poorer glycemic control. Methods Emerging adults with T1D wore a wrist actigraph and their own or provided continuous glucose monitor (CGM) concurrently 24 hours/day for 6-8 days. Participants completed a 10-minute psychomotor vigilance test (PVT) on a device, 3-minute Trail Making Test on paper, and questionnaires including twice daily Pittsburgh sleep diaries in Research Electronic Data Capture (REDCap). TST, sleep onset latency (SOL), sleep efficiency (SE), wake after sleep onset (WASO), and sleep fragmentation index (SFI) were determined via actigraphy, glycemic control via A1C, and glucose variability via CGM. The purpose of this descriptive study was to explore associations between TST, sleep variability (SD of TST), neurocognitive function (psychomotor vigilance and executive function) and diabetes outcomes (glycemia and distress). Results The sample included 36 emerging adults (mean age 22.8±3.1; 30.6% male; 91.7% White, 86.1% non-Hispanic; A1C mean 7.1±1.0%, BMI 27.3±4.8 kg/m2). Mean TST was 7.1±1.2 hours, SOL was 19.7±13.5 minutes, SE was 85.5±4.6%, WASO was 34.7±18.2 minutes, and SFI was 17.7±6.2. Shorter TST was associated with more severe sleepiness (r=-0.48,p=0.004) and more diabetes distress (r=-0.37, p=0.03). More sleep variability was associated with more severe sleepiness (r=0.36, p=0.03), longer response times (RT) ≥ 500ms (rho=0.39, p=0.02) measured via PVT, more nocturnal glucose variability (r=0.38, p=0.04), greater mean daily differences in glucose levels (r=0.42, p=0.02). Shorter mean RT was associated with more time in glucose range (rho=-0.37, p=0.04). Conclusion Improving TST and sleep variability are potential therapeutic targets to improve glucoregulation in this high-risk population. Researchers should consider within-person multi-level modeling to inform our understanding of the true nature of the sleep-glucose association in emerging adults with T1D. Support T32 NR0008346, Sigma Theta Tau International, Dexcom provided continuous glucose monitors (G4) free of charge for participants who did not have their own device.

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Associations Between Objective Sleep Behaviors and Blood Glucose Variability in Young Children With Type 1 Diabetes

Annals of Behavioral Medicine ◽

10.1093/abm/kaaa040 ◽

2020 ◽

Author(s):

Alexandra D Monzon ◽

Arwen M Marker ◽

Amy E Noser ◽

Mark A Clements ◽

Susana R Patton

Keyword(s):

Type 1 Diabetes ◽

Blood Glucose ◽

Young Children ◽

Sleep Onset ◽

Glycemic Variability ◽

Glucose Variability ◽

Sleep Onset Latency ◽

Onset Latency ◽

Blood Glucose Variability

Abstract Background Young children with Type 1 diabetes (T1D) are at risk for extreme blood glucose variability, a risk factor for suboptimal glycated hemoglobin A1c (HbA1c) and long-term health complications. We know that a reciprocal relationship exists between sleep and glycemic outcomes in older youth with T1D; however, little research has examined objective sleep in young children (<7 years) with T1D. Purpose This study examines bidirectional associations between sleep behaviors and glycemic variability in young children with T1D. Methods Thirty-nine young children with T1D (Mage 4.33 ± 1.46 years; MHbA1c 8.10 ± 1.06%) provided accelerometry data to objectively measure sleep onset latency, number of nighttime awakenings, and total sleep time. We also assessed HbA1c, average blood glucose, and glycemic variability (i.e., standard deviation of blood glucose from device downloads). We evaluated bidirectional relationships using multilevel modeling in SAS, with weekday/weekend as a Level 2 moderator. Results Children averaged 8.5 ± 1.44 hr of sleep per night, but only 12.8% met current sleep recommendations. Children experienced more nighttime awakenings, higher blood glucose, and more glycemic variability on weekends. Sleep onset latency and nighttime awakenings predicted greater glycemic variability on weekends, and weekend glycemic variability predicted increased nighttime awakenings. Conclusions Most young children with T1D did not meet sleep recommendations. Young children experienced more nighttime awakenings, higher blood glucose, and increased glycemic variability on weekends only, when routines may be less predictable. Findings suggest that one way families of young children with T1D may be able to decrease glycemic variability is to keep consistent routines on weekdays and weekends.

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