Inconsistent Sleep a Barrier to Glycemic Control in T1D

Inconsistent Sleep a Barrier to Glycemic Control in T1D
Experts test intervention to improve sleep habits in pediatric patients with T1D.

A consistent sleep schedule and regular number of hours may be more valuable than total sleep duration for managing type 1 diabetes (T1D) in pediatric patients, according to research published in Pediatric Diabetes.

The study, conducted by a multidisciplinary team at Monroe Carell Jr. Children’s Hospital at Vanderbilt, presented novel findings that tie variations in sleep durations to poorer diabetes-related outcomes. The researchers have since conducted a pilot study of a sleep-promoting intervention designed to improve sleep habits among teens with T1D.

“The main finding was that this type of program was feasible and acceptable for teens with T1D,” said Sarah Jaser, Ph.D., an associate professor of pediatrics at Vanderbilt University Medical Center and an author on both studies. “We observed a significant increase in sleep duration and efficiency among the teens that were randomized to our Sleep Coach intervention.”

Sleep Consistency Is Key

The first study that helped inform the intervention found that sleep variability was associated with less frequent blood glucose monitoring (BGM), higher HbA1c, and increased blood glucose. However, total sleep time and self-reported sleep quality were not independently linked to any negative outcomes. “Notably, it seems that consistency in sleep is even more important than sleep duration for diabetes outcomes,” Jaser said.

Children with T1D who have trouble sleeping have been shown to have poorer glycemic control, Jaser says, leading to increased insulin resistance. Her research reveals that an inconsistent sleep schedule is a potentially modifiable barrier to optimizing glycemic control.

For the first study, 65 adolescents between the ages of 13 and 17 years were asked to keep a sleep diary for 7 days and wear an ActiGraph watch that tracks sleep efficiency, sleep latency and sleep duration. The adolescents and their caregivers also completed a self-care inventory, which accounted for diet, exercise, BGM, insulin administration, and medical appointment attendance. HbA1c values were gathered at a regular diabetes clinic visit.

“Consistency in sleep is even more important than sleep duration for diabetes outcomes.”

‘Social Jetlag’ a Factor

The sleep variability found in the initial study was significantly associated with poorer diabetes management and was partially attributable to what is known as “social jetlag” – the difference between how long subjects slept on the weekdays versus weekends.

Participants slept an average of one hour more on weekends compared to weekdays, and BGM was greater on both weekend nights (72.3 versus 60 percent weekdays) and mornings (83.1 versus 76.9 percent weekdays). Participants reported going to sleep nearly an hour later and waking up two hours later on the weekend, as compared to weekdays.

“Even if teens with T1D have the same poor sleep hygiene as teens in the general population, such as cell phone use at bedtime – or all night! – and social jetlag, those with diabetes are likely to suffer more from the physiological and cognitive effects of insufficient or inconsistent sleep,” Jaser said.

Opportunities for Intervention

Only 23 percent of participants in the initial study reported obtaining sufficient sleep on school nights, but the total number of sleep hours was not associated with poorer diabetes management. The researchers also tracked caffeine and electronics use and found no significant relationship between either as it related to diabetes management or sleep habits on weekdays or weekends.

“Providers can start by asking about sleep – it is often overlooked as a potential risk or protective factor for diabetes management.”

Jaser suggests clinicians encourage T1D adolescents to find a regular sleep schedule and stick with it. The researcher’s newest study indicates educational materials and check-ins, such as those provided through the team’s Sleep Coach intervention, can help. Jaser and colleagues found teens in the intervention group reported a 48-minute increase in sleep duration. Teens who were not randomized to the intervention were 7.5 times more likely to report poor sleep quality after three months.

While the results are promising, the researchers still emphasize the importance of intervening at point of care. “Providers can start by asking about sleep – it is often overlooked as a potential risk or protective factor for diabetes management,” Jaser said.