A new review article shows scientific studies have consistently identified links between sleep problems and health outcomes in patients with type 1 diabetes (T1D). Despite the apparent links, there are no screening recommendations related to sleep in patients with the disease.
Significant evidence exists that healthy, sufficient sleep is important to the health outcomes of patients with type 1 diabetes (T1D), but a new article argues the issue needs more attention, more research in order to equip physicians to better treat these patients.
Writing in the journal Nature and Science of Sleep, Michelle M. Perfect, PhD, of the Department of Disability and Psychoeducational Studies at the University of Arizona, writes that scientific studies have found that sleep can affect glycemic control, poor diabetes management, and complications of diabetes.
“However, at the current juncture, the American Diabetes Association’s Standards of Medical Care are devoid of recommendations about how to address sleep in the management of T1DM,” she writes.
In order to increase advance understanding of links between T1D and sleep, Perfect reports on 60 studies to date which have assessed the issue. Their findings demonstrated a clear pattern.
“Rates of sleep disorders and problems across studies were consistently 15% or higher,” she writes. Perfect notes that as of 2017, the Standards of Medical Care in Diabetes include the recommendation that physicians assess a patient’s sleep quality and quantity, as well as evaluate for sleep-disordered breathing. However, that recommendation only applies to type 2 diabetes (T2D), and no similar recommendation has yet been issued for patients with T1D. The 15% mark is also in line with rates of other diseases, such as Hashimoto’s disease and celiac disease. The standards call for screening T1D patients for those diseases.
“This gap is most likely due to the varying ways in which sleep has been assessed, smaller sample sizes, and absence of longitudinal, case-controlled, or experimental studies in individuals with T1DM,” she writes. “Nonetheless, as more studies are published, the significance of these findings may warrant inclusion of sleep recommendations in future iterations of these guidelines.”
Though it’s not in the guidelines yet, Perfect says clinicians can use existing tools to screen patients for sleep-related problems. In children, the Children’s Sleep Habit Questionnaire or Pittsburgh Sleep Quality Index can be used. The new Children’s Report of Sleep Patterns is also a candidate. In addition, some continuous glucose monitors now generate sleep metrics. These sleep-related data have not yet been put through a formal regulatory validation process, but they might provide meaningful insights for physicians, she says.
In the meantime, Perfect told The American Journal of Managed Care® that additional research will be helpful in terms of solidifying the scientific understanding of sleep and T1D.
“I believe the scientific evidence would be strong with larger scale, multi-site studies that track the many facets of sleep longitudinally to examine co-occurring relations with health outcomes, experimental sleep manipulation studies that determine causal effects of sleep on outcomes, and interventional studies that target modifying sleep parameters (duration, timing, consistency, etc.),” she said.
Perfect noted that investigators have begun evaluating sleep modification as a direct means of improving outcomes for patients with T1D.
One study, out last month, found sleep-promoting interventions were successful at increasing sleep duration and quality in teenagers with T1D. The intervention did not affect glycated hemoglobin (A1C) levels. Perfect and colleagues have also been working on a study gauging the impact of sleep improvement on glycemic control; those results are currently being written up, she said.
Perfect MM. Sleep-related disorders in patients with type 1 diabetes mellitus: Current insights. Nat Sci Sleep. 2020;12:101-123. doi: 10.2147/NSS.S152555.