Supplemental light exposure improves sleep architecture in people with type 2 diabetes

Finkelstein

Clinical Exper Ophthalmology

et al. 2022

Background To evaluate the ability of handheld chromatic pupillometry to reveal and localise retinal neural dysfunction in diabetic patients with and without diabetic retinopathy (DR). Methods This cross‐sectional study included 82 diabetics (DM) and 93 controls (60.4 ± 8.4 years, 44.1% males). DM patients included those without (n = 25, 64.7 ± 6.3 years, 44.0% males) and with DR (n = 57, 60.3 ± 8.5 years, 64.9% males). Changes in horizontal pupil radius in response to blue (469 nm) and red (640 nm) light stimuli were assessed monocularly, in clinics, using a custom‐built handheld pupillometer. Pupillometric parameters (phasic constriction amplitudes [predominantly from the outer retina], maximal constriction amplitudes [from the inner and outer retina] and post‐illumination pupillary responses [PIPRs; predominantly from the inner retina]) were extracted from baseline‐adjusted pupillary light response traces and compared between controls, DM without DR, and DR. Net PIPR was defined as the difference between blue and red PIPRs. Results Phasic constriction amplitudes to blue and red lights were decreased in DR compared to controls (p < 0.001; p < 0.001). Maximal constriction amplitudes to blue and red lights were decreased in DR compared to DM without DR (p < 0.001; p = 0.02), and in DM without DR compared to controls (p < 0.001; p = 0.005). Net PIPR was decreased in both DR and DM without DR compared to controls (p = 0.02; p = 0.03), suggesting a wavelength‐dependent (and hence retinal) pupillometric dysfunction in diabetic patients with or without DR. Conclusions Handheld chromatic pupillometry can reveal retinal neural dysfunction in diabetes, even without DR. Patients with DM but no DR displayed primarily inner retinal dysfunction, while patients with DR showed both inner and outer retinal dysfunction.

Section: Discussioncontrasting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

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Retinal neural dysfunction in diabetes revealed with handheld chromatic pupillometry

Finkelstein

Clinical Exper Ophthalmology

et al. 2022

“…The many features of the selected studies are shown in Table 1. The participants in the studies selected were type I diabetes mellitus (T1DM) patients [55][56][57][58], T2DM patients [55,[58][59][60][61][62][63][64][65], pregnant women with gestational diabetes mellitus (GDM) [66][67][68], and patients with diabetic retinopathy (DR) [55]. Figure 1 shows the sample characteristics and psychometric or clinical instruments used to analyse the psychological alterations and primary outcomes related to the salivary biomarkers and psychological alterations.…”

Section: Resultsmentioning

confidence: 99%

“…In total, information was collected and analysed from 522 people with T2DM, 376 people with T1DM, and 65 women with GMD. A total of eight articles studied people with T2DM [55, [59][60][61][62][63][64][65], three studied people with T1DM [56,57,66], two studied women with GDM [67,68], and one article compared people with T2DM and people with T1DM [58].…”

Section: Design Of the Studies Type Of Dm And Salivary Biomarkersmentioning

confidence: 99%

Salivary Biomarkers Associated with Psychological Alterations in Patients with Diabetes: A Systematic Review

et al. 2022

The care of individuals with diabetes needs a holistic perspective, taking into account both the physical disease and the mental health problems that may be associated. Different studies show a higher prevalence of depression or anxiety issues in diabetes patients than in the general population, which is why diabetes can be considered one of the chronic diseases in which psychological care is crucial to maintain quality of life. The objective of this review is to examine the published articles that relate the bidirectional associations between objective and subjective measures of anxiety, depressive symptomatology, stress, sleep quality, and salivary biomarkers in patients with diabetes. For this, a search was carried out in the electronic databases PubMed, Cochrane, and SCOPUS using the keywords “diabetes”, “saliva”, “sleep”, “anxiety”, “depression”, and “stress” for works published up until May 2022 and limited to the English and Spanish languages. The sample comprised 14 articles, 5 of which analysed the associations between depressive symptomatology and salivary biomarkers in people with diabetes. Among the salivary biomarkers most frequently used to evaluate psychological alterations in persons with diabetes are cortisol and melatonin. Thus, significant changes in the levels of these biomarkers were observed in most studies. Four out of five studies reported a statistically significant relationship between increased salivary cortisol in the evening/midnight or the cortisol awakening response and depressive symptoms. In contrast, lower cortisol levels upon waking in the morning were observed when there was no depression or anxiety. Regarding the association between salivary cortisol values and sleep quality in patients with diabetes, lower morning cortisol values related to prolonged nighttime sleep were common in the analysed studies. Low melatonin concentrations showed a negative correlation with sleep quality. As it is an easy-to-apply and non-invasive method, the measurement of salivary biomarkers can be very useful for predicting psychological alterations in patients with diabetes. Further scientific studies are required to determine the sensitivity of these biological substances acting as biomarkers for detecting sleep disorders and psychological alterations.

Intestinal flora composition and fecal metabolic phenotype in elderly patients with sleep disorders combined with type 2 diabetes

Yin,

Xie,

Liu

et al. 2024

Aging Medicine

ObjectivesThis study aimed to determine whether type 2 diabetes (T2D) is an independent risk factor for sleep disorders in the elderly and explore the possible intestinal flora factors of sleep disorders combined with T2D in this population.MethodsAll hospitalized patients with sleep disorders aged ≥65 years between June and November 2023 were retrospectively analyzed, and they were divided into a sleep disorder group (n = 134) and a control group (n = 109). The logistic regression method was utilized to clarify the causal relationship between T2D and sleep disorders. For stool analyses, 42 patients were randomly extracted, which included the control group (n = 14), diabetes group (n = 14), and elderly patients with sleep disorders combined with the T2D group (ESdD) (n = 14). The composition feature of intestinal flora and metabolomics in the ESdD group was described through high‐throughput 16S rDNA sequencing and nontargeted analysis based on liquid chromatography–mass spectrometry.ResultsGender, body mass index (BMI), T2D, intestinal discomfort, and anxiety depression were independent risk factors for sleep disorders in the elderly. Notably, older individuals with T2D were 3.3 times more likely to experience sleep disorders than normal individuals. Compared with the control group, the ESdD group had decreased relative abundance of Barnesiella and Marvinbryantia, with 47 metabolites upregulated and 53 metabolites downregulated. The ESdD group showed a decrease in Lachnospiraceae_UCG_010, with 62 metabolites upregulated and 43 metabolites downregulated, compared with the diabetes group.ConclusionsDiabetes is an independent risk factor for sleep disorders in the elderly patients. Variations in intestinal flora and metabolism significantly influence the onset and progression of the ESdD group.