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Cited by 230Sleep and related disordersCircadian rhythm and melatoninSleep and Work-Related Fatigue

Cross-Sectional Associations Between Measures of Sleep and Markers of Glucose Metabolism Among Subjects With and Without Diabetes

Open access
Knutson, Kristen L., Van Cauter, Eve, Zee, Phyllis, Liu, Kiang, Lauderdale, Diane S.·2011·Diabetes Care
DOI 10.2337/dc10-1962PMC PMC3114508
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Abstract

OBJECTIVE: To examine whether sleep duration and quality are associated with fasting glucose, fasting insulin, or estimated insulin resistance in a community-based sample of early middle-aged adults. RESEARCH DESIGN AND METHODS: This was an ancillary study to the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Habitual sleep duration and fragmentation were estimated from 6 days of wrist actigraphy collected in 2003–2005. Insomnia was defined as self-reported difficulty falling asleep or waking up in the night three or more times per week plus average sleep efficiency of <80% based on actigraphy. Fasting blood samples to measure glucose and insulin were collected after the sleep measures during the CARDIA clinical examination in 2005–2006. Insulin resistance was estimated using the homeostatic model assessment (HOMA) method. Analyses were cross-sectional and stratified by the presence of diabetes. RESULTS: There was no association between sleep measures and fasting glucose, insulin, or HOMA in the 115 subjects without diabetes. Among the 40 subjects with diabetes, after adjustment for covariates, 10% higher sleep fragmentation was associated with a 9% higher fasting glucose level, a 30% higher fasting insulin level, and a 43% higher HOMA level. Insomnia was associated with a 23% higher fasting glucose level, a 48% higher fasting insulin level, and an 82% higher HOMA level. CONCLUSIONS: The observed association between poor sleep quality and higher glucose, insulin, and estimated insulin resistance among subjects with diabetes warrants further examination of the effect of sleep disturbances on glucose control in type 2 diabetes.

AI snapshot

Written from the paper’s full text.

TL;DR

In this cross-sectional CARDIA ancillary study, objectively measured sleep duration was not associated with fasting glucose, insulin, or HOMA-IR, but greater sleep fragmentation and insomnia were associated with worse glucose metabolism among participants with diabetes, not those without. The authors conclude that poor sleep quality may be clinically relevant for glycemic control in type 2 diabetes and warrants further study.

Key findings

  • Among the 40 subjects with diabetes, fully adjusted models showed that each 10% higher sleep fragmentation was associated with a 9% higher fasting glucose level, a 30% higher fasting insulin level, and a 43% higher HOMA level.
  • Insomnia among subjects with diabetes was associated with a 23% higher fasting glucose level, a 48% higher fasting insulin level, and an 82% higher HOMA level.
  • There was no association between sleep measures and fasting glucose, insulin, or HOMA in subjects without diabetes; the abstract states 115 subjects without diabetes, while Table 1 reports n=531 without diabetes and n=40 with diabetes (final sample 571). In unadjusted models among those without diabetes, frequent snoring and shorter sleep duration were associated with some outcomes, but these were not significant after adjustment; adjusted insomnia was associated with 14% lower fasting insulin and 14% lower HOMA.
  • Sleep duration was not associated with any outcome in either group, and frequent snoring was not significantly associated with outcomes in fully adjusted models.

Methods

  • Ancillary study to CARDIA at the Chicago site; 670 of 814 eligible participants consented, and the final analytic sample was 571 after excluding 9 with <3 days of actigraphy, 87 with reported fasting <8 h, 2 missing fasting glucose or insulin, and 1 with unknown diabetes status. Sleep was measured in 2003–2005 with wrist actigraphy (Actiwatch-16, 3 days on two occasions approximately 1 year apart) and questionnaires; fasting blood samples were collected in 2005–2006.
  • Diabetes was defined by fasting plasma glucose ≥6.99 mmol/L, self-reported diagnosis, or diabetes medication use. HOMA-IR was calculated as fasting insulin (mU/L) × fasting glucose (mmol/L)/22.5. Insomnia was defined as self-reported difficulty falling asleep or waking at night ≥3 times/week plus actigraphic sleep efficiency <80%; frequent snoring was based on the Berlin Sleep Apnea questionnaire.
  • Cross-sectional linear regressions were stratified by diabetes status; each sleep measure was entered into a separate model. Outcomes were natural-log transformed, and models were unadjusted and adjusted for age, race, sex, BMI, education, and income, using robust variance estimators.

Limitations

  • The paper states that the cross-sectional design cannot determine causal direction; there were no polysomnographic measures, so sleep disorders such as obstructive sleep apnea could not be accurately detected; fasting status was self-reported and not objectively verified; the diabetes subgroup included only 40 individuals; and sleep was not assessed immediately before the clinical examination.
  • Evident from the text: the small diabetes subgroup limits precision and generalizability, and multiple sleep predictors and outcomes were tested in separate models without stated adjustment for multiple comparisons.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.2337/dc10-1962

Cites

25 of 25 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 31 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    In subjects without diabetes, the associations of frequent snoring and shorter sleep duration with glucose, insulin, and HOMA were no longer statistically significant in the fully adjusted models.

    “but these associations were no longer statistically significant in the fully adjusted models.”
    Quote in the paperSubstantial claim
  • Findingown data

    Habitual sleep duration objectively assessed by multiple days of wrist actigraphy is not associated with markers of glucose metabolism assessed after an overnight fast in middle-aged adults with and without diabetes.

    “Our analyses suggest that habitual sleep duration objectively assessed by multiple days of wrist actigraphy is not associated with markers of glucose metabolism assessed after an overnight fast in middle-aged adults with and without diabetes.”
    Quote in the paperSubstantial claim
  • Findingown data

    Frequent snoring was not significantly associated with any of the metabolic measures in subjects with diabetes.

    “Frequent snoring was not significantly associated with any of the metabolic measures in subjects with diabetes.”
    Quote in the paperSubstantial claim
  • Findingown data

    Among subjects with diabetes, fragmented sleep and insomnia were associated with fasting glucose levels that were 0.7-1.8 mmol/L higher than in those who had well-consolidated sleep or no insomnia.

    “Among subjects with diabetes, fragmented sleep and insomnia were associated with fasting glucose levels that were 0.7–1.8 mmol/L higher than in those who had well-consolidated sleep or no insomnia.”
    Quote in the paperSubstantial claim
  • Findingown data

    We did not observe significant differences in sleep fragmentation between subjects with and without type 2 diabetes.

    “We did not observe significant differences in sleep fragmentation between subjects with and without type 2 diabetes”
    Quote in the paperSubstantial claim
  • May combine two claims. 25
  • Classified as probably not a substantial claim. 12

  • May combine two claims.

    Findingown data

    Among subjects with diabetes, greater sleep fragmentation and insomnia, but not sleep duration, were associated with higher fasting glucose, higher fasting insulin, and higher HOMA even in the fully adjusted models.

    “Among subjects with diabetes, greater sleep fragmentation and insomnia, but not sleep duration, were associated with higher fasting glucose, higher fasting insulin, and higher HOMA even in the fully adjusted models.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Among subjects without diabetes, the fully adjusted models showed insomnia was associated with lower insulin levels and lower HOMA.

    “Among subjects without diabetes, the fully adjusted models showed insomnia was associated with lower insulin levels and, as a direct result of lower insulin levels, lower HOMA.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In subjects without diabetes in the unadjusted models, shorter sleep duration was associated with higher insulin levels and higher HOMA values.

    “shorter sleep duration was associated with higher insulin levels and higher HOMA values”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Among subjects with diabetes, a 10% higher sleep fragmentation was associated with a 9% higher fasting glucose level, a 30% higher fasting insulin level, and a 43% higher HOMA value.

    “a 10% higher sleep fragmentation was associated with a 9% higher fasting glucose level, a 30% higher fasting insulin level, and a 43% higher HOMA value.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    BMI, fasting glucose, fasting insulin, HOMA-IR, and prevalence of insomnia were all significantly higher in the diabetes group compared with the no diabetes group.

    “BMI, fasting glucose, fasting insulin, HOMA-IR, and prevalence of insomnia were all significantly higher in the diabetes group.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Sleep fragmentation and insomnia were both associated with higher fasting glucose, insulin, and estimated insulin resistance, but in subjects with diabetes only.

    “Sleep fragmentation and insomnia, however, were both associated with higher fasting glucose, insulin, and estimated insulin resistance, but in subjects with diabetes only.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Among subjects with diabetes, insomnia was associated with a 23% higher fasting glucose level, a 48% higher fasting insulin level, and an 82% higher HOMA level.

    “insomnia among subjects with diabetes was associated with a 23% higher fasting glucose level, a 48% higher fasting insulin level, and an 82% higher level of HOMA.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Among subjects without diabetes, having insomnia was associated with a 14% lower fasting insulin level and a 14% lower HOMA level.

    “The regression coefficients indicated that having insomnia was associated with a 14% lower fasting insulin level and a 14% lower HOMA level.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In subjects without diabetes in the unadjusted models, frequent snoring was associated with higher fasting glucose, higher insulin, and higher HOMA values.

    “In subjects without diabetes in the unadjusted models, frequent snoring was associated with higher fasting glucose, higher insulin, and higher HOMA values”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In an exploratory analysis, the association between insomnia and lower fasting insulin in nondiabetic individuals became significant after adjustment for BMI and reflected the contribution of nondiabetic individuals with insomnia who were not overweight (BMI <25 kg/m2).

    “An exploratory analysis showed that this association became significant after adjustment for BMI, and reflected the contribution of the nondiabetic individuals with insomnia who were not overweight (BMI <25 kg/m2).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The unadjusted mean (SD) fasting insulin level was 43.3 (20.7) pmol/L in the 22 subjects with insomnia and 54.9 (22.4) pmol/L in the 145 individuals without insomnia.

    “The unadjusted mean (SD) fasting insulin level was 43.3 (20.7) pmol/L in the 22 subjects with insomnia and 54.9 (22.4) pmol/L in the 145 individuals without insomnia.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    Fasting glucose, fasting insulin, and HOMA-IR were all transformed using the natural log in the analyses because they were skewed to the right.

    “Fasting glucose, fasting insulin, and HOMA-IR were all transformed using the natural log in the analyses because they were skewed to the right.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The second regression model was adjusted for age, race, sex, BMI, education, and income.

    “the second model was adjusted for age, race, sex, BMI, education, and income.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    These laboratory studies lasted only 1 to 2 weeks and the results may not reflect the effects of habitual short sleep.

    “These laboratory studies lasted only 1 to 2 weeks and the results may not reflect the effects of habitual short sleep.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [4] Spiegel, 1999, Impact of sleep debt on metabolic and endocrine function, Lancet source

      Not checked in the free run.

    • cites [5] Buxton, 2010, Sleep restriction for 1 week reduces insulin sensitivity in healthy men

      Not checked in the free run.

    • cites [6] Nedeltcheva, 2009, Exposure to recurrent sleep restriction in the setting of high caloric intake and physical inactivity results in increased insulin resistance and reduced glucose tolerance, J Clin Endocrinol Metab source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The robust variance estimator was used in linear regression models to calculate confidence intervals and P values.

    “The robust variance estimator was used in linear regression models to calculate confidence intervals and P values.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    A small Italian study did use wrist actigraphy to compare the sleep of patients with type 2 diabetes with healthy control subjects and found higher sleep fragmentation in the patients with diabetes.

    “A small Italian study did use wrist actigraphy to compare the sleep of patients with type 2 diabetes with healthy control subjects and found higher sleep fragmentation in the patients with diabetes (14).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] Trento, 2008, Sleep abnormalities in type 2 diabetes may be associated with glycemic control, Acta Diabetol source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    All analyses were stratified by diabetes status.

    “Because the mechanisms of glucose regulation are markedly different between people with and without diabetes, all analyses were stratified by diabetes status.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Wrist actigraphy has been validated against polysomnography, demonstrating a correlation for sleep duration between 0.82 in people with insomnia and 0.97 in healthy subjects.

    “Wrist actigraphy has been validated against polysomnography, demonstrating a correlation for sleep duration between 0.82 in people with insomnia and 0.97 in healthy subjects (16).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Jean-Louis, 1997, The actigraph data analysis software: I. A novel approach to scoring and interpreting sleep-wake activity, Percept Mot Skills source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationreasoning

    Each of the pathways (lower cerebral glucose utilization, elevated sympathetic activity, higher evening cortisol, alterations in growth hormone release, elevated inflammation) is already dysregulated in the diabetic state and is likely to be more vulnerable to an additional perturbation, such as sleep disturbance.

    “Each of these pathways is already dysregulated in the diabetic state and is likely to be more vulnerable to an additional perturbation, such as sleep disturbance.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Laboratory studies in healthy subjects have indicated that lower cerebral glucose utilization, elevated sympathetic activity, higher evening cortisol levels, alterations in growth hormone release, and elevated markers of inflammation are on the pathways that mediate the adverse effects of reduced sleep duration or quality on glucose metabolism, or both.
    • Rests on an assumption: The mechanisms responsible for glucose homeostasis are already deficient in subjects with diabetes and therefore more vulnerable to additional perturbation.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    We excluded 9 participants with <3 days of wrist actigraphy data, 87 who reported a fasting period of <8 h before the clinical examination, 2 who were missing a value for fasting glucose or fasting insulin at 20 years, and one whose diabetes status could not be ascertained, which resulted in a final sample size of 571 participants.

    “We excluded 9 participants with <3 days of wrist actigraphy data, 87 who reported a fasting period of <8 h before the clinical examination, 2 who were missing a value for fasting glucose or fasting insulin at 20 years, and one whose diabetes status could not be ascertained, which resulted in a final sample size of 571 participants.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Laboratory studies of sleep restriction in healthy subjects observed a significant deleterious impact of experimentally reduced sleep duration or quality on glucose metabolism in response to a glucose challenge, but did not observe a significant change in fasting levels of glucose or insulin.

    “These studies observed a significant deleterious impact of experimentally reduced sleep duration or quality on glucose metabolism in response to a glucose challenge, but did not observe a significant change in fasting levels of glucose or insulin.”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [4] Spiegel, 1999, Impact of sleep debt on metabolic and endocrine function, Lancet source

      Not checked in the free run.

    • cites [5] Buxton, 2010, Sleep restriction for 1 week reduces insulin sensitivity in healthy men

      Not checked in the free run.

    • cites [6] Nedeltcheva, 2009, Exposure to recurrent sleep restriction in the setting of high caloric intake and physical inactivity results in increased insulin resistance and reduced glucose tolerance, J Clin Endocrinol Metab source

      Not checked in the free run.

    • cites [19] Tasali, 2008, Slow-wave sleep and the risk of type 2 diabetes in humans, Proc Natl Acad Sci USA source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    It is possible that the effects of sleep disturbances are more pronounced in subjects with diabetes because the mechanisms responsible for glucose homeostasis are already deficient and therefore more vulnerable.

    “It is possible that the effects of sleep disturbances are more pronounced in subjects with diabetes because the mechanisms responsible for glucose homeostasis are already deficient and therefore more vulnerable.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The mechanisms responsible for glucose homeostasis are already deficient in subjects with diabetes and therefore more vulnerable to additional perturbation.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    As part of quality control, reassays of stored samples were conducted and recalibration equations were developed for the glucose and insulin values from the 2005-2006 CARDIA examination.

    “As part of quality control, reassays of stored samples were conducted and recalibration equations were developed for the glucose and insulin values from the 2005–2006 CARDIA examination.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Many observational studies have found cross-sectional associations indicating a higher prevalence of diabetes among short sleepers and among those with poor subjective sleep quality.

    “Many have found cross-sectional associations that indicated a higher prevalence of diabetes among short sleepers (7–9) and among those with poor subjective sleep quality (10,11).”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [7] Gottlieb, 2005, Association of sleep time with diabetes mellitus and impaired glucose tolerance, Arch Intern Med source

      Not checked in the free run.

    • cites [8] Chaput, 2007, Association of sleep duration with type 2 diabetes and impaired glucose tolerance, Diabetologia source

      Not checked in the free run.

    • cites [9] Chao, Sleep duration is a potential risk factor for newly diagnosed type 2 diabetes mellitus

      Not checked in the free run.

    • cites [10] Jennings, 2007, Self-reported sleep quality is associated with the metabolic syndrome, Sleep source

      Not checked in the free run.

    • cites [11] Suarez, 2008, Self-reported symptoms of sleep disturbance and inflammation, coagulation, insulin resistance and psychosocial distress: evidence for gender disparity, Brain Behav Immun source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    These observational studies all relied on self-reported sleep, which may not be very accurate.

    “These observational studies all relied on self-reported sleep, which may not be very accurate (13).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] Lauderdale, 2008, Self-reported and measured sleep duration: how similar are they?, Epidemiology source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    For 92% of participants in these analyses, 6 days of actigraphy recording were available and the remaining 8% had 3 to 5 days of actigraphy recording.

    “For 92% of participants in these analyses, 6 days of actigraphy recording were available and the remaining 8% had 3 to 5 days of actigraphy recording.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Insomnia may be associated with increased activity in the hypothalamic-pituitary-adrenal axis, which could impair glucose metabolism, particularly in those whose metabolism is already compromised.

    “Insomnia may be associated with increased activity in the hypothalamic-pituitary-adrenal axis (22), which could impair glucose metabolism, particularly in those whose metabolism is already compromised.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] Vgontzas, 2002, Sleep, the hypothalamic-pituitary-adrenal axis, and cytokines: multiple interactions and disturbances in sleep disorders, Endocrinol Metab Clin North Am source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Sleep was not assessed immediately before the clinical examination.

    “Finally, sleep was not assessed immediately before the clinical examination”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    We do not have polysomnographic measures of sleep in this cohort, so we cannot accurately detect sleep disorders like obstructive sleep apnea.

    “Second, we do not have polysomnographic measures of sleep in this cohort, so we cannot accurately detect sleep disorders like obstructive sleep apnea”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given

    Participants reported having fasted for at least 8 h, but there was no way to objectively verify whether they were indeed fasting.

    “A third limitation is that participants reported having fasted for at least 8 h, but there was no way to objectively verify whether they were indeed fasting.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Obstructive sleep apnea appears to be highly prevalent in patients with type 2 diabetes and is associated with poorer glycemic control.

    “which appears to be highly prevalent in patients with type 2 diabetes (23) and is associated with poorer glycemic control (24).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [23] Aronsohn, 2010, Impact of untreated obstructive sleep apnea on glucose control in type 2 diabetes, Am J Respir Crit Care Med source

      Not checked in the free run.

    • cites [24] Punjabi, 2004, Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study, Am J Epidemiol source

      Not checked in the free run.

31 of 31

  • The paper relies on this without support.

    Laboratory studies in healthy subjects have indicated that lower cerebral glucose utilization, elevated sympathetic activity, higher evening cortisol levels, alterations in growth hormone release, and elevated markers of inflammation are on the pathways that mediate the adverse effects of reduced sleep duration or quality on glucose metabolism, or both.

    “Laboratory studies in healthy subjects have indicated that lower cerebral glucose utilization, elevated sympathetic activity, higher evening cortisol levels, alterations in growth hormone release, and elevated markers of inflammation are on the pathways that mediate the adverse effects of reduced sleep duration or quality on glucose metabolism, or both.”

  • The paper relies on this without support.

    Several prospective studies found higher rates of incident diabetes associated with shorter sleep durations.

    “Several prospective studies found higher rates of incident diabetes associated with shorter sleep durations.”

  • The paper relies on this without support.

    Patients with type 2 diabetes are at a higher risk of diabetes complications if their glucose levels are poorly controlled.

    “Patients with type 2 diabetes are at a higher risk of diabetes complications if their glucose levels are poorly controlled.”

  • The paper relies on this without support.

    The mechanisms responsible for glucose homeostasis are already deficient in subjects with diabetes and therefore more vulnerable to additional perturbation.

    “because the mechanisms responsible for glucose homeostasis are already deficient and therefore more vulnerable.”
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Diabetes-group insomnia insulin confidence interval is inconsistent with its coefficient

    Major

    For the adjusted diabetes-group insomnia result, the reported confidence interval has a midpoint of 0.321, not the reported coefficient of 0.389. Its lower bound also crosses zero despite the reported P value of 0.019.

    Reported 0.389 · recomputed 0.321

  • Abstract says there were no associations in subjects without diabetes

    Major

    The abstract's blanket statement conflicts with the fully adjusted results for subjects without diabetes: insomnia was associated with lower insulin and HOMA, with P values of 0.030 and 0.038, respectively.

  • Abstract gives the wrong number of participants without diabetes

    Minor

    The abstract says there were 115 subjects without diabetes, but Table 1 lists 531. The table's 531 subjects without diabetes and 40 with diabetes also sum to the stated final sample of 571.

3 of 3

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Related

Authors
Knutson, K. L., Van Cauter, E., Zee, P., Liu, K., & Lauderdale, D. S.
Affiliations
  • University of Chicago (US)
  • Department of Medicine, University of Chicago, Chicago, Illinois
  • Northwestern University (US)
Corresponding author
Knutson, Kristen L.
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2011-04-20
Volume
34
Issue
5
Pages
1171-1176
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc10-1962
PMC
PMC3114508
OpenAlex
W1967340496
Semantic Scholar
010fc1dbc063f2587f71da0c481460fb422c89ac
Cited by
230
References
27
Citations by year
2026: 6 · 2025: 12 · 2024: 8 · 2023: 11 · 2022: 18 · 2021: 9 · 2020: 12 · 2019: 13 · 2018: 13 · 2017: 19 · 2016: 20 · 2015: 22 · 2014: 16 · 2013: 25 · 2012: 21
FWCI
27.52
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetes Care (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (n01hc95095-66-0-1, n01hc48050-59-0-1, n01hc48048-58-0-1, n01hc48047-55-0-1, n01hc48049-61-0-1)
  • U.S. Public Health Service
  • National Institute on Aging (P01AG011412)
  • National Heart, Lung, and Blood Institute (N01HC48050, N01 HC 95095, N01 HC048048, N01-HC-048049, NO1-HC-48049, N01 HC095095, N01 HC048050, N01-HC48048, N01-HC-48-049, N01 HC048047, NO1-HC-95095, N01-HC-480-47)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
Keywords
sleep duration, sleep quality, sleep fragmentation, insomnia, diabetes mellitus, insulin resistance, fasting blood glucose, fasting insulin, glucose metabolism, type 2 diabetes, middle-aged adults, actigraphy
MeSH terms
Adult, Blood Glucose, Cross-Sectional Studies, Diabetes Mellitus, Fasting, Female, Humans, Sleep Initiation and Maintenance Disorders, Insulin, Insulin Resistance, Male, Middle Aged, Sleep, Actigraphy

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