Impact of sleep behavior on glycemic control in type 1 diabetes: the role of social jetlag

Abstract

Background: Sleep behavior is changing toward shorter sleep duration and a later chronotype. It results in a sleep debt that is acquitted on work-free days, inducing a small but recurrent sleep misalignment each week, referred to as "social jetlag". These sleep habits could affect health through misalignment with circadian rhythms. Objectives: The primary objective is to address the impact of sleep behavior on glycemic control, assessed by HbA1c, in patients with type 1 diabetes, independently of other lifestyle or sleep-related factors. The secondary objective is to address whether circadian phase affects glycemic control. Design: In total, 80 adult patients with type 1 diabetes (46% female) were included in a clinical cohort study. Methods: Sleep behavior was addressed objectively by a 7-day actimetry, lifestyle by questionnaires, sleep breathing disorders by nocturnal oximetry and circadian phase by dim light melatonin onset (DLMO). Results: Univariate analyses showed that chronotype (r = 0.23, P = 0.042) and social jetlag (r = 0.30, P = 0.008) were significantly associated with HbA1c. In multivariable analysis, social jetlag was the only sleep habit independently associated with HbA1c (β = 0.012 (0.006; 0.017), P < 0.001). HbA1c was lower in patients with a social jetlag below versus above the median (7.7% (7.1-8.7) and 8.7% (7.6-9.8), P = 0.011). DLMO was not associated with HbA1c. However, the later the DLMO, the worse the sleep efficiency (r = −0.41, P < 0.001) and fragmentation index (r = 0.35, P = 0.005). Conclusions: Social jetlag, a small but recurrent circadian misalignment, is associated with worse glycemic control in type 1 diabetes, whereas circadian phase is not. Further intervention studies should address the potential improvement of glycemic control by correcting social jetlag.

Social jetlag and metabolic control in non-communicable chronic diseases: a study addressing different obesity statuses

“…16 , found in patients with type 1 diabetes a positive association between HbA1c and social jetlag (β = 0.012, p < 0.001); HbA1c levels were lower in patients with social jetlag below (≤49 min) versus above (>49 min) the median (7.7% and 8.7%, respectively; p = 0.011). However, in two studies also examining the associations between social jetlag and glycaemic control markers, conducted in pre-diabetic subjects 18 and type 2 diabetes patients 17 , no significant associations were found between circadian misalignment and metabolic control.…”

“…15 , demonstrated that social jetlag in young adults (n = 1037; 52% males, 38 years) was a risk factor for higher than recommended glycated haemoglobin (HbA1c) levels (>5.7%) and a higher risk of being metabolically unhealthy obese (MUO). In a few studies that have analysed patients with metabolic abnormalities, social jetlag has been significantly associated with HbA1c levels in type 1 diabetes individuals (n = 80; 46% female) 16 . However, no associations have been found between social jetlag and parameters related to glycaemic control in type 2 diabetics 17 or pre-diabetic individuals 18 .…”

Sleep in Type 1 Diabetes: Implications for Glycemic Control and Diabetes Management

“…Shifting between a weekday and a weekend schedule perpetuates social jetlag, and this variability in sleep timing can have significant consequences for individuals with T1D. One study of adults with T1D used wrist actigraphy to capture data on sleep duration, latency, fragmentation, and efficiency, which was used to calculate social jetlag, or the difference in total sleep time between nights [14]. Social jetlag at the beginning of the work week led to an increasing sleep debt, for which patients compensated on weekend nights by oversleeping.…”

“…Social jetlag at the beginning of the work week led to an increasing sleep debt, for which patients compensated on weekend nights by oversleeping. This shift in chronotype and the resulting social jetlag were found to be independently linked to higher HbA1c [14]. People with T1D may be even more likely to suffer from social jetlag; one study found that during the weekends, adolescents with T1D demonstrated sleep extension more than twice the length of their peers without T1D [15].…”

Clocks in the clinic: circadian rhythms in health and disease

“…Later chronotype is associated with higher HbA1c levels, independent of confounding sleep and clinical variables, in T2DM83 and prediabetes 84. There are conflicting reports of the association of chronotype with glycaemic control in type 1 diabetes: one study reports that more SJL is associated with poorer glycaemic control in adults,85 while in an adolescent cohort chronotype or SJL was not associated with HbA1c levels 86…”