Circadian rhythm and gestational diabetes: working conditions, sleeping habits and lifestyle influence insulin dependency during pregnancy

Friederike Weschenfelder,Ekkehard Schleußner,Karolin Lohse,Thomas Lehmann,Tanja Groten

doi:10.1007/s00592-021-01708-8

Friederike Weschenfelder, Ekkehard Schleußner + Show 3 more

Open Access

https://doi.org/10.1007/s00592-021-01708-8

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Abstract

ObjectiveManagement of gestational diabetes (GDM) is currently changing toward a more personalized approach. There is a growing number of GDM patients requiring only a single dose of basal insulin at night to achieve glucose control. Well-known risk factors like obesity, parity and family history have been associated with GDM treatment requirements. Sleep quality and lifestyle factors interfering with the circadian rhythm are known to affect glucose metabolism. The aim of this study was to investigate the impact of such lifestyle factors on insulin requirement in GDM patients, in particular on long-acting insulin to control fasting glucose levels.Research design and methodsA total of 805 patients treated for GDM between 2012 and 2016 received a study questionnaire on lifestyle conditions. Sleep quality and work condition categories were used for subgroup analysis. Independent effects on treatment approaches were evaluated using multivariate regression.ResultsIn total, 235 (29.2%) questionnaires returned. Women reporting poor sleep conditions had higher pre-pregnancy weight and BMI, heavier newborns, more large for gestational age newborns and higher rates of hyperbilirubinemia. Treatment requirements were related to sleep and work condition categories. Multivariate regression for ‘Basal’ insulin-only treatment revealed an adjOR 3.4 (CI 1.23–9.40, p < 0.05) for unfavorable work conditions and adjOR 4.3 (CI 1.28–14.50, p < 0.05) for living with children.ConclusionsOur findings suggest that external stressors like unfavorable work conditions and living with children are independently associated with the necessity of long-acting insulin at night in GDM patients. Thus, fasting glucose levels of pregnant women presenting with such lifestyle conditions may be subject to close monitoring.

Highlights

Treatment of gestational diabetes (GDM) is currently changing from uniform standard therapy regimes toward a more individualized and patient-orientated management
Sleep habits and other lifestyle factors interfering with the circadian rhythm have been shown to increase glucose levels and the risk of diabetes in general [8,9,10]
Women with poor sleep quality were significantly heavier than women with ‘good sleep quality’ (77 kg (IQR 68–91.5) vs. 71 kg (63–86), p < 0.05) and showed higher BMI values before pregnancy (27.7 kg/ m2 (23.7–33.9) vs. 26.1 kg/m2 (23.1–30.4))

Summary

Introduction

Treatment of gestational diabetes (GDM) is currently changing from uniform standard therapy regimes toward a more individualized and patient-orientated management. Predictors for insulin therapy during pregnancy in previous studies included values of the 75 g oral glucose tolerance test (oGTT) and maternal anthropometrics showing that. Acta Diabetologica (2021) 58:1177–1186 mostly elevated prepregnancy maternal BMI and levels of fasting glucose, 2-h blood glucose and HbA1c at time of diagnosis were associated with the requirement of insulin treatment during pregnancy [2,3,4]. Sleep habits and other lifestyle factors interfering with the circadian rhythm have been shown to increase glucose levels and the risk of diabetes in general [8,9,10].

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Discussion

Conclusion