Subjective sleep disturbances and glycemic control in adults with long-standing type 1 diabetes: The Pittsburgh’s Epidemiology of Diabetes Complications study
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Aims To date, studies on sleep disturbances in type 1 diabetes (T1D) have been limited to youth and/or small samples. We therefore assessed the prevalence of subjective sleep disturbances and their associations with glycemia and estimated insulin sensitivity in individuals with long-standing T1D.Methods We conducted a cross-sectional study including 222 participants of the Epidemiology of Diabetes Complications study of childhood-onset T1D attending the 25-year examination (mean age=52years, diabetes duration=43years). The Berlin Questionnaire (risk of obstructive sleep apnea, OSA), the Epworth Sleepiness Scale (daytime sleepiness), and the Pittsburgh Sleep Quality Index (sleep quality, bad dreams presence, and sleep duration) were completed. Associations between sleep disturbances and poor glycemic control (HbA1c⩾7.5%/58mmol/mol), log-transformed HbA1c, and estimated insulin sensitivity (estimated glucose disposal rate, eGDR, squared) were assessed in multivariable regression.Results The prevalences of high OSA risk, excessive daytime sleepiness, poor sleep quality, and bad dreams were 23%, 13%, 41%, and 26%, respectively, with more women (51%) reporting poor sleep quality than men (30%, p=0.004). Participants under poor glycemic control were twice as likely to report bad dreams (p=0.03), but not independently (p=0.07) of depressive symptomatology. Sleep duration was directly associated with HbA1c among individuals with poor glycemic control, but inversely in their counterparts (interaction p=0.002), and inversely associated with eGDR (p=0.002).Conclusions These findings suggest important interrelationships between sleep, gender, depressive symptomatology, and glycemic control, which may have important clinical implications. Further research is warranted to examine the mechanism of the interaction between sleep duration and glycemic control.
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Sleep disturbances including poor sleep quality and shorter sleep duration are associated with worsening glycemic levels in type 1 diabetes.
“On the other hand, sleep disturbances including poor sleep quality and shorter sleep duration are associated with worsening glycemic levels in type 1 diabetes (154,155).”
From The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) (2021) · cites this paper as [154]
The Results (§3.2; page not provided) find that shorter sleep duration was associated with higher HbA1c only among participants with good glycemic control; the association ran in the opposite direction among those with poor control. The same section reports no association between poor sleep quality and poor glycemic control, so the sentence overgeneralizes the duration finding and does not support its poor-sleep-quality component. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn type 1 diabetes, estimates of poor sleep range from 30% to 50%.
“In type 1 diabetes, estimates of poor sleep range from 30% to 50% (441), and estimates of moderate to severe obstructive sleep apnea are >50% (436).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:<i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [441]
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MethodSleep and glycemic control in type 1 diabetes
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“On the other hand, sleep disturbances including poor sleep quality and shorter sleep duration are associated with worsening glycemic levels in type 1 diabetes (154,155).”
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“On the other hand, sleep disturbances including poor sleep quality and shorter sleep duration are associated with worsening glycaemic levels in type 1 diabetes [154, 155].”
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Sleep-wake characteristics, daytime sleepiness, and glycemia in young adults with type 1 diabetes
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“The participants with uncontrolled glycemia revealed a higher frequency of nightmares compared to the patients with better glycemic control [56].”
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“sleeping, sleep quality, and obstructive sleep apnea have previously been linked to worse glycemic control [34, 35].”
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“…has been mixed, with some researchers reporting an association between a shorter sleep duration and poorer glycaemia (Borel et al., 2013; Denic-Roberts et al., 2016; Reutrakul et al., 2016; von Schnurbein et al., 2018), or between a lower daytime alertness and poorer glycaemia (Griggs,…”
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“Pittsburgh’s Epidemiology of Diabetes Complications Study, in whichwere enrolled 222 patients with type 1 diabetes, showed no association between sleep quality and insulin sensitivity in unadjusted and adjusted univariate linear regression model (p < .05 for all) (Denic-Roberts et al. 2016).”
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Nightmare and Abnormal Dreams: Rare Side Effects of Metformin?
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“The occurrence of bad dreams and poor sleep quality among patients with T2DMwere associatedwith poor glycemic control and duration of disease [7, 8].”
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Sleep Quality and Cognitive Function in Type 1 Diabetes
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Sleep Disturbances in Type 1 Diabetes and Mitigating Cardiovascular Risk
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An Unusual Association Between Metformin and Nightmares: A Case Report
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“If compared gender-wise, a greater proportion of female participants exhibited signs of poor sleep quality than male participants [7].”
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Obstructive Sleep Apnoea and Type 1 Diabetes Mellitus: A Neglected Relationship?
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“Denić-Roberts et al. [27] also found a higher prevalence of OSA in male than female sub - jects with T1DM (p < 0.05).”
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“These disturbances included sleep fragmentation, nocturia, pain during sleep, difficulty falling asleep, and bad dreams, all of which were suspected to be linked to diabetes [3,16].”
New Insight into the Role of Obstructive Sleep Apnea in Cardiometabolic Diseases
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“This is consistent with other studies showing that women with OSA have signi fi cantly higher HbA1c levels, suggesting poorer glycemic control 37,38 .”
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- Authors
- Denic-Roberts, H., Costacou, T., & Orchard, T. J.
- Affiliations
- University of Pittsburgh (US)
- Corresponding author
- Costacou, Tina
- Orchard, Trevor J.
- Venue
- Diabetes Research and Clinical Practice
- Publisher
- Elsevier BV
- Published
- 2016-09
- Volume
- 119
- Pages
- 1-12
- ISSN
- 0168-8227 (ISSN-L)
- PMC
- PMC5024530
- OpenAlex
- W2431952300
- Cited by
- 51
- References
- 47
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 8 · 2023: 8 · 2022: 9 · 2021: 5 · 2020: 3 · 2019: 2 · 2018: 4 · 2017: 2 · 2016: 1
- FWCI
- 4.26
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Diabetes Research and Clinical Practice (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (DK34818)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Keywords
- type 1 diabetes, sleep disorders, glycemic control, HbA1c, insulin sensitivity, glucose disposal rate, obstructive sleep apnea, daytime sleepiness, sleep quality, nightmares, sleep duration, depressive symptoms, sex differences, long-standing diabetes
- MeSH terms
- Blood Glucose, Cross-Sectional Studies, Diabetes Mellitus, Type 1, Female, Humans, Male, Middle Aged, Prospective Studies, Surveys and Questionnaires, Sleep Wake Disorders, Cohort Studies, Diabetes Complications
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