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

Nefs, Giesje; Bazelmans, E.; Donga, Esther; Tack, Cees J.; Galan, Bastiaan E. de

doi:10.1111/dme.14211

Cited by 20 publications

(11 citation statements)

References 54 publications

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“…In addition, nocturnal hypoglycaemia can also negatively affect sleep quality [50]. Observational data suggest that sleep disturbances or impaired sleep quality are more prevalent in people with diabetes [51]. Indeed, there is evidence that reduced sleep is related to the occurrence of type 2 diabetes, heightened inflammation, insulin resistance and appetite and weight gain [52][53][54].…”

Section: Sleep and Glycaemic Controlmentioning

confidence: 99%

Coordination of glucose monitoring, self-care behaviour and mental health: achieving precision monitoring in diabetes

et al. 2022

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Monitoring of glucose plays an essential role in the management of diabetes. However, to fully understand and meaningfully interpret glucose levels, additional information on context is necessary. Important contextual factors include data on behaviours such as eating, exercise, medication-taking and sleep, as well as data on mental health aspects such as stress, affect, diabetes distress and depressive symptoms. This narrative review provides an overview of the current state and future directions of precision monitoring in diabetes. Precision monitoring of glucose has made great progress over the last 5 years with the emergence of continuous glucose monitoring (CGM), automated analysis of new glucose variables and visualisation of CGM data via the ambulatory glucose profile. Interestingly, there has been little progress in the identification of subgroups of people with diabetes based on their glycaemic profile. The integration of behavioural and mental health data could enrich such identification of subgroups to stimulate precision medicine. There are a handful of studies that have used innovative methodology such as ecological momentary assessment to monitor behaviour and mental health in people’s everyday life. These studies indicate the importance of the interplay between behaviour, mental health and glucose. However, automated integration and intelligent interpretation of these data sources are currently not available. Automated integration of behaviour, mental health and glucose could lead to the identification of certain subgroups that, for example, show a strong association between mental health and glucose in contrast to subgroups that show independence of mental health and glucose. This could inform precision diagnostics and precision therapeutics. We identified just-in-time adaptive interventions as a potential means by which precision monitoring could lead to precision therapeutics. Just-in-time adaptive interventions consist of micro-interventions that are triggered in people’s everyday lives when a certain problem is identified using monitored behaviour, mental health and glucose variables. Thus, these micro-interventions are responsive to real-life circumstances and are adaptive to the specific needs of an individual with diabetes. We conclude that, with current developments in big data analysis, there is a huge potential for precision monitoring in diabetes. Graphical abstract

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Section: Sleep and Glycaemic Controlmentioning

confidence: 99%

Coordination of glucose monitoring, self-care behaviour and mental health: achieving precision monitoring in diabetes

et al. 2022

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“…One of these factors that has been increasingly acknowledged is sleep. Over the past two decades, substantial evidence has accumulated highlighting the importance of sleep in glucose regulation [1]. Only recently has the American Diabetes Association's Standards of Medical Care recommended assessment of sleep patterns as part of comprehensive medical evaluation [2].…”

Section: Introductionmentioning

confidence: 99%

“…Although self-reported sleep measures are frequently used, they are prone to over-or underestimation of sleep as compared with objective assessments [4]. Among people with type 1 diabetes, suboptimal subjective sleep quality is very common [1,5]. Both biological and psychosocial factors can affect sleep quality in this patient population.…”

Section: Introductionmentioning

confidence: 99%

Sleep quality and glycaemic variability in a real-life setting in adults with type 1 diabetes

et al. 2021

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Aims/hypothesis Suboptimal subjective sleep quality is very common in adults with type 1 diabetes. Reducing glycaemic variability is a key objective in this population. To date, no prior studies have examined the associations between objectively measured sleep quality and overnight glycaemic variability in adults with type 1 diabetes. We aimed to test the hypothesis that poor sleep quality would be associated with greater overnight glycaemic variability. Methods Data were collected in the home setting from 20 adults (ten male and ten female participants) with type 1 diabetes who were current insulin pump users. Simultaneous assessments of objective sleep quality (Zmachine Insight+) and continuous glucose monitoring (CGM) were performed over multiple nights (up to 15 nights) in each participant. Due to the real-life nature of this study, the participants kept their usual CGM alerts for out-of-range glucose values. Sleep quality was categorised as 'good' or 'poor' using a composite of objective sleep features (i.e. sleep efficiency, wake after sleep onset and number of awakenings) based on the National Sleep Foundation's consensus criteria. Glycaemic variability was quantified using SD and CV of overnight glucose values based on overnight CGM profiles. Results A total of 170 nights were analysed. Overall, 86 (51%) nights were categorised as good sleep quality, and 84 (49%) nights were categorised as poor sleep quality. Using linear mixed-effects models, poor sleep quality was significantly associated with greater glycaemic variability as quantified by SD (coefficient: 0.39 [95% CI 0.10, 0.67], p = 0.009) and CV (coefficient: 4.35 [95% CI 0.8, 7.9], p = 0.02) of overnight glucose values, after accounting for age, sex, BMI and overnight insulin dose. There was large inter-and intra-individual variability in sleep and glycaemic characteristics. Both pooled and individual-level data revealed that the nights with poor sleep quality had larger SDs and CVs, and, conversely, the nights with good sleep quality had smaller SDs and CVs. No associations were found between sleep quality and time spent in the target glucose range, or above or below the target glucose range, where CGM alarms are most likely to occur. Conclusions/interpretation Objectively measured sleep quality is associated with overnight glycaemic variability in adults with type 1 diabetes. These findings highlight an important role of sleep quality in overnight glycaemic control in type 1 diabetes. They also provide a strong incentive to both patients and healthcare providers for considering sleep quality in personalised type 1 diabetes glycaemic management plans. Future studies should investigate the mechanisms linking sleep quality to glycaemic variability.

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“…Several authors concluded that there is a high prevalence of sleep disturbances in patients with DM [ 35 , 49 , 50 ]. In the recent work by Nefs et al [ 51 ], the reciprocal relationship between DM and sleep was approached from a behavioral science perspective, and it was stated that sleep quality should be considered with the same importance as diet and exercise in DM care.…”

Section: Discussionmentioning

confidence: 99%

Is There an Association between Sleep Disorders and Diabetic Foot? A Scoping Review

Fernández-Torres

Ruiz-Muñoz

Belloso

et al. 2021

JCM

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Diabetic foot is associated with a low quality of life since physical disabilities, mood disturbances and psychological disorders are frequent. One of the most important biological processes to ensure quality of life is sleep. Sleep disorders can impair glycemic control in patients with diabetes mellitus or even cause long-term type 2 diabetes mellitus. The aim of this study is to carry out a scoping review about the association between sleep cycle disorders and diabetic foot. PubMed, Scopus, CINAHL, PEDro, Cochrane Library, SCIELO and EMBASE databases were chosen for the search and the following terms were used: “diabetic foot”,“sleep*”,“rest-activity”,“mood” and“behavior”. All the studies should include outcome variables about sleep and diabetic foot. Finally, 12 articles were selected, all of whichwere observational. The most frequent variables were those regarding diabetic foot ulcer aspects and diabetic neuropathy on one side, and obstructive sleep apnea, sleep duration and sleep quality on the other side. The results suggest that there is a possible association between obstructive sleep apnea and the presence or history of diabetic foot ulcers. No direct associations between sleep quality or sleep duration and diabetic foot or diabetic foot ulcer variables have been found.

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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

Cited by 20 publications

References 54 publications

Coordination of glucose monitoring, self-care behaviour and mental health: achieving precision monitoring in diabetes

Coordination of glucose monitoring, self-care behaviour and mental health: achieving precision monitoring in diabetes

Sleep quality and glycaemic variability in a real-life setting in adults with type 1 diabetes

Is There an Association between Sleep Disorders and Diabetic Foot? A Scoping Review

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