Sleep and type 1 diabetes in children and adolescents: Proposed theoretical model and clinical implications

Abstract

Youth with type 1 diabetes mellitus (T1D) experience more sleep disturbances and shorter sleep durations compared to their healthy peers. Researchers have now uncovered the negative mental health and physical health outcomes associated with poor sleep in youth with T1D. The field of T1D sleep research currently operates under the broad notion that sleep behaviors impact treatment adherence, which ultimately lead to worse long‐term health outcomes. This model however does not explain how behavior influences T1D management and sleep outcomes on a day‐to‐day basis, leading to difficulties in providing tailored treatment recommendations. In this review, we present a theoretical framework that describes the recursive cycle between sleep behaviors, T1D outcomes, and symptoms of negative affect/stress over a 24‐hour period. This model is guided by the sleep literature, showing a clear relationship between poor sleep and negative affect, and the T1D literature demonstrating a link between poor sleep and disease management for youth with T1D. Further, emerging literature indicates a need for additional parent sleep assessment considering that T1D management and fear of hypoglycemia negatively impact parent sleep behaviors. Recommendations are provided to move the field toward effective intervention studies and new areas of research to evaluate and modify the proposed model.

Sweet dreams or bitter nightmare: a narrative review of 25 years of research on the role of sleep in diabetes and the contributions of behavioural science

“…Summary of biological and behavioural pathways relating sleep and diabetes, based on the models of Barone and Menna‐Barreto and Monzon et al .…”

“…In a qualitative study among adolescents aged 13–17 years with type 1 diabetes, several teens described becoming more 'forgetful' or 'lazy' about diabetes management and making unhealthy food choices in case of suboptimal sleep the night before . Emotional problems (including symptoms of depression, anxiety and stress) are likely to play a role as well in the relationship between suboptimal sleep and self‐care . Suboptimal sleep has been associated with worse emotional well‐being, which, in turn, may negatively affect self‐management behaviours and glucose levels .…”

“…Emotional problems (including symptoms of depression, anxiety and stress) are likely to play a role as well in the relationship between suboptimal sleep and self‐care . Suboptimal sleep has been associated with worse emotional well‐being, which, in turn, may negatively affect self‐management behaviours and glucose levels .…”

“…Diabetes is a growing health problem of global dimensions. Only recently has it been acknowledged that suboptimal sleep can impact on the development and overall regulation of diabetes, whereas several components of diabetes and its management may affect sleep . As of 2017, the American Diabetes Association's Standards of Medical Care have recommended assessment of sleep pattern and duration as part of the comprehensive medical evaluation, given their links to glycaemic outcomes.…”

Sleep characteristics in young adults with type 1 diabetes

“…There is an identified need for interventions involving parental assessment of sleep in younger populations (e.g., children and adolescents) with T1D. [47][48][49][50][51] To our knowledge there are no intervention studies in which reduction of fear of nocturnal hypoglycemia for those living with or directly involved in a young adult's T1D management is targeted. Practitioners working with young adults with T1D need to manage expectations and fears associated with nocturnal hypoglycemia as these issues may contribute negatively to sleep quality and shorter sleep duration.…”