Abstract
BackgroundDeterioration of sleep quality has been reported to contribute to the incidence of diabetes and may be responsible for glycemic status in diabetes. The present study explored the relationship between sleep quality and glycemic variability in patients with type 2 diabetes (T2D).MethodsWe recruited 111 patients with T2D for this cross-sectional study. Each patient underwent flash glucose monitoring for 14 days to obtain glycemic variability parameters, such as standard deviation of glucose (SD), coefficient of variation of glucose (CV), mean amplitude of glycemic excursions (MAGE), mean of daily differences (MODD), and time in glucose range of 3.9–10 mmol/L (TIR3.9–10). After 14 days of flash glucose monitoring, each patient received a questionnaire on the Pittsburgh Sleep Quality Index (PSQI) to evaluate subjective sleep quality. HbA1c was also collected to assess average glucose.ResultsHbA1c was comparable among the subgroups of PSQI score tertiles. Across ascending tertiles of PSQI scores, SD, CV and MAGE were increased, while TIR3.9–10 was decreased (p for trend < 0.05), but not MODD (p for trend = 0.090). Moreover, PSQI scores were positively correlated with SD, CV, MODD and MAGE (r = 0.322, 0.361, 0.308 and 0.354, respectively, p < 0.001) and were inversely correlated with TIR3.9–10 (r = − 0.386, p < 0.001). After adjusting for other relevant data by multivariate linear regression analyses, PSQI scores were independently responsible for SD (β = 0.251, t = 2.112, p = 0.041), CV (β = 0.286, t = 2.207, p = 0.033), MAGE (β = 0.323, t = 2.489, p = 0.018), and TIR3.9–10 (β = − 0.401, t = − 3.930, p < 0.001) but not for MODD (β = 0.188, t = 1.374, p = 0.177).ConclusionsIncreased glycemic variability assessed by flash glucose monitoring was closely associated with poor subjective sleep quality evaluated by the PSQI in patients with T2D.
Highlights
Deterioration of sleep quality has been reported to contribute to the incidence of diabetes and may be responsible for glycemic status in diabetes
Across ascending tertiles of Pittsburgh Sleep Quality Index (PSQI) scores, total cholesterol (TC) levels were significantly increased, but age, ratio of females, Body mass index (BMI),waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), diabetes duration, hypertension prevalence, TG, high-density lipoprotein cholesterol (HDLC), low-density lipoprotein cholesterol (LDLC), uric acid (UA), estimated glomerular filtration rate (eGFR), Area under the glucose curve (AUCglu), Area under the C-peptide curve (AUCcp), AUCgluca and hemoglobin A1c (HbA1c) did not show any differences among the tertiles of PSQI scores
Regarding glucose-lowering therapies, the frequency of metformin use was increased when the tertiles of PSQI scores increased, but lifestyle alone, insulin treatments, insulin secretagogues, α-Glucosidase inhibitors (AGIs), dipeptidyl peptidase-4 inhibitors (DPP-4Is) and SGLT-2Is were comparable among the tertiles of PSQI scores
Summary
Deterioration of sleep quality has been reported to contribute to the incidence of diabetes and may be responsible for glycemic status in diabetes. The present study explored the relationship between sleep quality and glycemic variability in patients with type 2 diabetes (T2D). At present, ongoing research efforts worldwide are trying to screen intrinsic and external risk factors for increased glycemic variability, which can help guide the development of appropriate therapeutic regimens to improve glycemic variability and subsequent diabetic prognosis. In several previous studies, poor sleep quality was demonstrated to contribute to glycemic disturbances and the occurrence and progression of diabetes [17, 18]. We hypothesized that poor sleep quality may be an important risk factor for increased glycemic variability. The Pittsburgh Sleep Quality Index (PSQI) is a potent tool to assess subjective sleep quality and is widely applied in sleep studies [19, 20]
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