Young Children with Type 1 Diabetes: Sleep, Health-Related Quality of Life, and Continuous Glucose Monitor Use

Abstract

While children with type 1 diabetes (T1D) and their parents report significant sleep problems, few studies have focused on young children and included health-related quality of life (HRQOL) as an outcome of sleep disturbance. In addition, relatively little is known about the use of diabetes devices, such as continuous glucose monitors (CGMs), in young children and their link with sleep disturbances. This brief report examines the relationship between sleep quality and HRQOL and explores sleep disturbances related to CGM use in a sample of young children with T1D. Data are from the baseline of a behavioral intervention pilot for 46 parents of children ages 2-5 years with T1D. Parents reported on their child's sleep disturbances as a result of nighttime blood glucose monitoring (NBGM). Sleep was measured objectively in a subset of children (N = 11) who wore accelerometers for a 5-day period. All parents completed measures of pediatric and parental HRQOL. Greater child sleep disturbance due to NBGM was associated with lower pediatric HRQOL. Child sleep disturbances were negatively associated with parental life satisfaction. In addition, children who used CGM experienced fewer sleep disturbances than those who did not. However, parents of children who used CGM experienced greater sleep disturbances related to a higher frequency of NBGM. Pediatric and parental HRQOL were most related to child sleep disturbances by NBGM. CGM use may be associated with better child sleep, as parents are less likely to wake their child for NBGM, although CGM use may also be associated with greater sleep difficulties in parents. Future studies should further explore the relationship between sleep and technology use and impact on clinical outcomes in young children with T1D and their parents.

Intermittently Scanned and Continuous Glucose Monitor Systems: A Systematic Review on Psychological Outcomes in Pediatric Patients

“…In a RCT, adolescents' sleep quality measured with the PSQI questionnaire was not different in youth using rtCGM ( 60 ). On the contrary, parental sleep quality improved with the use of rtCGM, both when measured with the PSQI questionnaire as well by accelerometry devices in parents of adolescents and of young children, respectively ( 62 ).…”

“…In most of the studies the perceived QoL assessed by the PedsQL in patients and caregivers, resulted improved by the use of rtCGM ( 55 , 62 ). In some other studies no variations in the PedsQL were reported ( 13 , 14 ), probably due to the number of variables that may influence the perceived QoL in diabetes or due to the short-term follow-up.…”

“…In a qualitative study, 9 pairs of children and parents reported improved sleep quality with the sensor use [( 61 ), Low]. A prospective study on 46 children and their parents found that kids who used rtCGM experienced fewer sleep disturbances than those who did not, but their parents had greater sleep disturbances related to a higher frequency of nocturnal blood glucose monitoring (NBGM) [( 62 ), Moderate]. A RCT on youth aged 14–24 years using rtCGM, reported there were no differences in sleep quality between sensors users and non-users [( 60 ), High].…”

“…RtCGM systems has been reported to improve QoL in children, for easier management of insulin dosages, diet, physical activity and in school and extra-home management [( 54 , 55 , 62 ), Moderate-Low]. Similarly, in parents of youths, rtCGM has been reported to improve QoL and well-being [( 51 , 56 ), Moderate-Low].…”

Assessing Diabetes Distress and Sleep Quality in Young Adults with Type 1 Diabetes Using FreeStyle Libre: A Prospective Cohort Study

“…A recent integrative review of 17 original studies on sleep and T1DM reported that young adults with T1DM have large variations in sleep duration, poor quality of sleep, and sleep deficiency [20]. An improvement in sleep quality has been observed in young children (2-5 years) using continuous glucose monitoring; however, continuous glucose monitoring negatively impacted parents' sleep [21]. However, the impact of newer diabetic technologies on sleep quality in young adults with T1DM has not been extensively studied.…”