Relationship and variation of diabetes related symptoms, sleep disturbance and sleep‐related impairment in adults with type 2 diabetes

Zhu, Bingqian; Quinn, Laurie; Fritschi, Cynthia

doi:10.1111/jan.13482

Cited by 26 publications

(21 citation statements)

References 47 publications

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“…Similar results have been reported in a cross-sectional study among patients diagnosed with T2D, where patients reported higher levels of pain and fatigue that were closely related to sleep disturbance [ 15 ]. Another cross-sectional study reported that patients who were very active in their self-care related to T2D had lower depression, better social outcomes, and better physical function [ 16 ].…”

Section: Discussionsupporting

confidence: 88%

Changes in Patient-Reported Outcome Measures With a Technology-Supported Behavioral Lifestyle Intervention Among Patients With Type 2 Diabetes: Pilot Randomized Controlled Clinical Trial

Jiwani¹,

Wang²,

Berndt³

et al. 2020

JMIR Diabetes

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Background In the United States, more than one-third of the adult population is obese, and approximately 25.2% of those aged ≥65 years have type 2 diabetes (T2D), which is the seventh leading cause of death. It is important to measure patient-reported outcomes and monitor progress or challenges over time when managing T2D to understand patients’ perception of health and quantify the impact of disease processes or intervention effects. The evaluation of patient-reported outcome measures (PROMs) is especially important among patients with multiple chronic conditions in which clinical measures do not provide a complete picture of health. Objective This study examined the feasibility of collecting Patient-Reported Outcome Measurement Information System (PROMIS) measures, and preliminarily evaluated changes in PROMIS scores and compared the scores with standard scores of the general US population. The parent study is a pilot randomized controlled clinical trial testing three different modes (mobile health [mHealth], paper diary, and control) of self-monitoring in a behavioral lifestyle intervention among overweight or obese patients with T2D. Methods Patients with comorbid overweight or obesity and a diagnosis of T2D for at least 6 months were recruited from a diabetes education program. Participants were randomized to the following three groups: mHealth, paper diary, and control (standard of care) groups. Paper diary and mHealth experimental groups received additional behavioral lifestyle intervention education sessions, as well as tools to self-monitor weight, physical activity, diet, and blood glucose. All participants completed PROMIS-57 and PROMIS-Global Health (GH) version 1.0 questionnaires during visits at baseline, 3 months, and 6 months. The PROMIS-57 includes the following seven domains: anxiety, depression, fatigue, pain interference, physical function, satisfaction with participation in social roles, and sleep disturbance. The PROMIS-GH is composed of the following two domains: global mental health and global physical health. Results A total of 26 patients (mHealth, 11; paper diary, 9; control, 6) were included in our analysis. The study sample was predominantly African American (68%) and female (57%), with a mean age of 54.7 years and a mean BMI of 37.5 kg/m2. All patients completed the PROMIS-57 and PROMIS-GH questionnaires, and we compared the mean scores of the three groups to investigate potential differences. No relevant differences were noted across the groups. However, positive trends were noted in both intervention (mHealth and paper diary) groups in the middle (month 3) and end (month 6) of the study. Conclusions Our pilot study provides evidence for the feasibility of using PROMIS questionnaires to record important components of T2D-related symptoms among overweight or obese individuals. The results from our study support the use of PROMIS questionnaires to provide clinicians and researchers with a benchmark for assessing the overall need for symptom management and determining the success or challenges of an intervention. Trial Registration ClinicalTrials.gov NCT02858648; https://clinicaltrials.gov/ct2/show/NCT02858648

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Section: Discussionsupporting

confidence: 88%

Changes in Patient-Reported Outcome Measures With a Technology-Supported Behavioral Lifestyle Intervention Among Patients With Type 2 Diabetes: Pilot Randomized Controlled Clinical Trial

Jiwani¹,

Wang²,

Berndt³

et al. 2020

JMIR Diabetes

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“…By the same token, sleep disorders (SD) have been shown to affect around 20-30% of the western population on a daily or weekly basis, leading to a lower quality of life [1]. These disorders have also been reported to be a risk factor for diseases such as diabetes, and they can encourage the presence of diabetes complications [1][2][3][4]. In fact, between 42-77% [3] of patients with type-2 diabetes mellitus (DM-2) are reported to suffer from sleep disorders, although few studies have analyzed their relationship with patient outcomes and quality of life [5].…”

Section: Introductionmentioning

confidence: 99%

“…In this vein, several studies have found a relationship between SD and neuropathic pain in patients with DM-2, highlighting the need to include detailed assessments of pain when exploring the SD of these patients [3]. The analysis of sensory phenotypes is a more frequently recommended strategy in patients with neuropathic pain because different phenotypes have been shown to reveal different neurobiological pain mechanisms [11,12], which could explain the heterogeneity of the patients [12] and the variability in clinical outcomes [11,13,14].…”

Section: Introductionmentioning

confidence: 99%

Sleep Characteristics in Diabetic Patients Depending on the Occurrence of Neuropathic Pain and Related Factors

Naranjo

Dueñas

Barrera

et al. 2020

IJERPH

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This study aims to compare the sleep characteristics (structure and quality) in patients with type-2 diabetes mellitus with and without diabetic neuropathic pain (DNP), and to investigate the relationship of sensory phenotypes, anxiety, and depression with sleep quality in DNP patients. A cross-sectional study was performed in patients with type-2 diabetes mellitus and neuropathy. Patients were classified into two groups—with or without neuropathic pain—according to the “Douleur Neuropathique-4 (DN4)” scale. Sleep characteristics and quality (Medical Outcomes Study—MOS-sleep), pain phenotype (Neuropathic Pain Symptom Inventory—NPSI), mood status (Hospital Anxiety and Depression scale—HADS), pain intensity (Visual Analogue Scale—VAS), and quality of life (SF-12v2) were measured. The sample included 130 patients (65 with DNP). The mean scores in all the dimensions of the MOS-sleep scale were higher (more disturbances) in the DNP patients. Higher scores in anxiety or depression, greater intensity of pain or a higher score in the paroxysmal pain phenotype were associated with lower sleep quality in DNP patients. A shorter duration of the diabetes and lower levels of glycated hemoglobin were also associated with lower sleep quality. The results show the relationship between DNP and sleep quality, and the importance of assessing sensory phenotypes and mental comorbidities in these patients. Taking these factors into consideration, to adopt a multimodal approach is necessary to achieve better clinical results.

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“…In addition, various T2D symptoms may explain the variation in sleep parameters including frequent nocturnal urination, hyperglycemia-related food consumption, hypoglycemia symptoms, obesity, pain, and distress [ 30 ]. A recent study showed that diabetes-related symptoms including neuropathic pain, diabetes distress, and depressive symptoms were more likely associated with sleep disturbances [ 31 ]. However, it is important to elucidate the additive effects of insomnia symptoms on sleep parameters in individuals with T2D.…”

Section: Introductionmentioning

confidence: 99%

Sleep Efficiency and Total Sleep Time in Individuals with Type 2 Diabetes with and without Insomnia Symptoms

et al. 2020

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There is increasing awareness of the high prevalence of insomnia symptoms in individuals with type 2 diabetes (T2D). Past studies have established the importance of measuring sleep parameters using measures of central tendency and variability. Additionally, subjective and objective methods involve different constructs due to the discrepancies between the two approaches. Therefore, this study is aimed at comparing the averages of sleep parameters in individuals with T2D with and without insomnia symptoms and comparing the variability of sleep parameters in these individuals. This study assessed the between-group differences in the averages and variability of sleep efficiency (SE) and total sleep time (TST) of 59 participants with T2D with and without insomnia symptoms. Actigraph measurements and sleep diaries were used to assess sleep parameter averages and variabilities calculated by the coefficient of variation across 7 nights. Mann–Whitney U tests were utilized to compare group differences in the outcomes. Validated instruments were used to assess the symptoms of depression, anxiety, and pain as covariates. Objective SE was found to be statistically lower on average (85.98±4.29) and highly variable (5.88±2.57) for patients with T2D and insomnia symptoms than in those with T2D only (90.23±6.44 and 3.82±2.05, respectively). The subjective average and variability of SE were also worse in patients with T2D and insomnia symptoms, with symptoms of depression, anxiety, and pain potentially playing a role in this difference. TST did not significantly differ between the groups on averages or in variability even after controlling for age and symptoms of depression, anxiety, and pain. Future studies are needed to investigate the underlying mechanisms of worse averages and variability of SE in individuals with T2D and insomnia symptoms. Additionally, prompting the associated risk factors of insomnia symptoms in individuals with T2D might be warranted.

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Relationship and variation of diabetes related symptoms, sleep disturbance and sleep‐related impairment in adults with type 2 diabetes

Cited by 26 publications

References 47 publications

Changes in Patient-Reported Outcome Measures With a Technology-Supported Behavioral Lifestyle Intervention Among Patients With Type 2 Diabetes: Pilot Randomized Controlled Clinical Trial

Changes in Patient-Reported Outcome Measures With a Technology-Supported Behavioral Lifestyle Intervention Among Patients With Type 2 Diabetes: Pilot Randomized Controlled Clinical Trial

Sleep Characteristics in Diabetic Patients Depending on the Occurrence of Neuropathic Pain and Related Factors

Sleep Efficiency and Total Sleep Time in Individuals with Type 2 Diabetes with and without Insomnia Symptoms

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