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

The DOI matches its Crossref record, with a small difference in title or year; 25 of the 27 references it cites were found in a registry or an index; none of the 31 sources its claims cite is checked for support yet.

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

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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.

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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.

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Crossref · 10.2337/dc10-1962

Cites

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Claims the paper makes

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None of the sources cited for this claim have been checked yet.
In the paper
“Laboratory studies that manipulated bedtimes observed impaired glucose metabolism after sleep restriction compared with sleep extension (4–6).”
§ Cross-Sectional Associations Between Measures of Sleep and Markers of Glucose Metabolism Among Subjects With and Without Diabetes > Abstract > CONCLUSIONS
What the sources say
- Not checked yetcites [4] Spiegel, 1999, Impact of sleep debt on metabolic and endocrine function, Lancet source
- Not checked yetcites [5] Buxton, 2010, Sleep restriction for 1 week reduces insulin sensitivity in healthy men
- Not checked yetcites [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
Load-bearingStrength:plain· not yet calibratedCausal:direct· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
None of the sources cited for this claim have been checked yet.
In the paper
“The lack of association between sleep duration or fragmentation and fasting glucose among subjects without diabetes in our sample is consistent with laboratory studies of sleep restriction in both young and middle-aged healthy subjects (4–6,19).”
§ Cross-Sectional Associations Between Measures of Sleep and Markers of Glucose Metabolism Among Subjects With and Without Diabetes > CONCLUSIONS
What the sources say
- Not checked yetcites [4] Spiegel, 1999, Impact of sleep debt on metabolic and endocrine function, Lancet source
- Not checked yetcites [5] Buxton, 2010, Sleep restriction for 1 week reduces insulin sensitivity in healthy men
- Not checked yetcites [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 yetcites [19] Tasali, 2008, Slow-wave sleep and the risk of type 2 diabetes in humans, Proc Natl Acad Sci USA source
Load-bearingStrength:plain· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes

Show all 20 claims

It may state two separate claims as one. 25
Probably not a substantial claim. 12

None of the sources cited for this claim have been checked yet.
In the paper
“These laboratory studies lasted only 1 to 2 weeks and the results may not reflect the effects of habitual short sleep.”
§ Cross-Sectional Associations Between Measures of Sleep and Markers of Glucose Metabolism Among Subjects With and Without Diabetes > Abstract > CONCLUSIONS
What the sources say
- Not checked yetcites [4] Spiegel, 1999, Impact of sleep debt on metabolic and endocrine function, Lancet source
- Not checked yetcites [5] Buxton, 2010, Sleep restriction for 1 week reduces insulin sensitivity in healthy men
- Not checked yetcites [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
Strength:hedged· not yet calibratedCausal:conditional· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
It may state two separate claims as one.
In the paper
“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).”
§ Cross-Sectional Associations Between Measures of Sleep and Markers of Glucose Metabolism Among Subjects With and Without Diabetes > Abstract > CONCLUSIONS
What the sources say
- Not checked yetcites [14] Trento, 2008, Sleep abnormalities in type 2 diabetes may be associated with glycemic control, Acta Diabetol source
Strength:plain· not yet calibratedCausal:correlational· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
It may state two separate claims as one.
In the paper
“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).”
§ Cross-Sectional Associations Between Measures of Sleep and Markers of Glucose Metabolism Among Subjects With and Without Diabetes > RESEARCH DESIGN AND METHODS
What the sources say
- Not checked yetcites [16] Jean-Louis, 1997, The actigraph data analysis software: I. A novel approach to scoring and interpreting sleep-wake activity, Percept Mot Skills source
Strength:boosted· not yet calibratedCausal:correlational· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passes
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Cross-Sectional Associations Between Measures of Sleep and Markers of Glucose Metabolism Among Subjects With and Without Diabetes > CONCLUSIONS
Load-bearingStrength:hedged· not yet calibratedCausal:conditional· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: fails
Probably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.
- 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.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
§ Cross-Sectional Associations Between Measures of Sleep and Markers of Glucose Metabolism Among Subjects With and Without Diabetes > CONCLUSIONS
What the sources say
- Not checked yetcites [4] Spiegel, 1999, Impact of sleep debt on metabolic and endocrine function, Lancet source
- Not checked yetcites [5] Buxton, 2010, Sleep restriction for 1 week reduces insulin sensitivity in healthy men
- Not checked yetcites [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 yetcites [19] Tasali, 2008, Slow-wave sleep and the risk of type 2 diabetes in humans, Proc Natl Acad Sci USA source
Load-bearingStrength:plain· not yet calibratedCausal:direct· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Cross-Sectional Associations Between Measures of Sleep and Markers of Glucose Metabolism Among Subjects With and Without Diabetes > CONCLUSIONS
Load-bearingStrength:hedged· not yet calibratedCausal:conditional· not yet calibrated
Tests✓ Asserted: passes✗ Checkable: fails✓ Load-bearing: passes✓ Based: passes
Probably not a substantial claim. It may be too vague to check against evidence.
- Rests on an assumption: The mechanisms responsible for glucose homeostasis are already deficient in subjects with diabetes and therefore more vulnerable to additional perturbation.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ Cross-Sectional Associations Between Measures of Sleep and Markers of Glucose Metabolism Among Subjects With and Without Diabetes > Abstract > CONCLUSIONS
What the sources say
- Not checked yetcites [7] Gottlieb, 2005, Association of sleep time with diabetes mellitus and impaired glucose tolerance, Arch Intern Med source
- Not checked yetcites [8] Chaput, 2007, Association of sleep duration with type 2 diabetes and impaired glucose tolerance, Diabetologia source
- Not checked yetcites [9] Chao, Sleep duration is a potential risk factor for newly diagnosed type 2 diabetes mellitus
- Not checked yetcites [10] Jennings, 2007, Self-reported sleep quality is associated with the metabolic syndrome, Sleep source
- Not checked yetcites [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
Load-bearingStrength:plain· not yet calibratedCausal:correlational· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
It may state two separate claims as one.
In the paper
“These observational studies all relied on self-reported sleep, which may not be very accurate (13).”
§ Cross-Sectional Associations Between Measures of Sleep and Markers of Glucose Metabolism Among Subjects With and Without Diabetes > Abstract > CONCLUSIONS
What the sources say
- Not checked yetcites [13] Lauderdale, 2008, Self-reported and measured sleep duration: how similar are they?, Epidemiology source
Strength:hedged· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
It may state two separate claims as one.
In the paper
“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.”
§ Cross-Sectional Associations Between Measures of Sleep and Markers of Glucose Metabolism Among Subjects With and Without Diabetes > CONCLUSIONS
What the sources say
- Not checked yetcites [22] Vgontzas, 2002, Sleep, the hypothalamic-pituitary-adrenal axis, and cytokines: multiple interactions and disturbances in sleep disorders, Endocrinol Metab Clin North Am source
Load-bearingStrength:hedged· not yet calibratedCausal:conditional· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“which appears to be highly prevalent in patients with type 2 diabetes (23) and is associated with poorer glycemic control (24).”
§ Cross-Sectional Associations Between Measures of Sleep and Markers of Glucose Metabolism Among Subjects With and Without Diabetes > CONCLUSIONS
What the sources say
- Not checked yetcites [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 yetcites [24] Punjabi, 2004, Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study, Am J Epidemiol source
Strength:hedged· not yet calibratedCausal:correlational· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passes
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

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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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: Knutson, Kristen L.
Zee, Phyllis
Liu, Kiang
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: hybrid
doi.org
Licence: cc-by-nc-nd
creativecommons.org/licenses/by-nc-nd/3.0/ (vor, 3787 d)
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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Cross-Sectional Associations Between Measures of Sleep and Markers of Glucose Metabolism Among Subjects With and Without Diabetes

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