DF21-0402 Excessive Daytime Sleepiness Is Associated with Failure of Treatment Targets Attainment in Type 2 Diabetes

Abstract

Background: The relationship between excessive daytime sleepiness (EDS) and glycemic control in people with type 2 diabetes (T2D) had been reported. However, the relationships of EDS with blood pressure and lipid control, as well as overall attainment of treatment targets remain unclear. Aim: To examine the association between EDS and treatment targets attainment in T2D. Method: This was a cross-sectional analysis of people with T2D enrolled in the Hong Kong Diabetes Register (HKDR). EDS was defined as a score >10 based on the Epworth Sleepiness Scale (ESS). Insomnia and anxiety/depression states were assessed using the Insomnia Severity Index (ISI) and the EQ-5D questionnaires respectively. Sleep habits including habitual snoring were assessed by a validated sleep questionnaire. Treatment targets attainment was defined as (1) glycated haemoglobin (HbA1c) < 7% (2) blood pressure < 140/90 mmHg, and (3) low density lipoprotein cholesterol (LDL-C) < 2.6 mmol/L. Results: Between 6th July 2010 and 27th May 2015, a total of 3637 T2D from HKDR were included in the present analysis. Among them, 19.8% had EDS. Using multivariate logistic regression analysis, EDS was associated with failure of attainment of all three treatment targets [Odds Ratio (OR) = 1.53 (95% confidence interval, CI=1.20, 1.95), p < 0.001] and LDL-C target [OR= 1.22 (95% CI= 1.02, 1.46), p = 0.033] after adjustment for age, gender, body mass index (BMI), T2D duration, insomnia and anxiety/depression status, use of anti-diabetic agents, anti-hypertensives, lipid regulating drugs and aspirin. For subgroup analysis of T2D with obesity (BMI > 25kg/m2), there were associations between EDS and failure to attain all three treatment targets [OR = 1.77 (95% CI=1.29, 2.43), p < 0.001], HbA1c target [OR = 1.32 (95% CI=1.05, 1.66), p = 0.018] and LDL-C target [OR = 1.29 (95% CI=1.03, 1.62), p = 0.029]. In contrast, there was no significant association between EDS and treatment targets in non-obese T2D. After further adjustment for habitual snoring, the association between EDS and failure to attain all three treatment targets [OR = 1.68 (95% CI= 1.21, 2.34), p = 0.002] and HbA1c target [OR = 1.28 (95% CI= 1.00, 1.63), p = 0.046] remained significant in obese T2D, while that with LDL-C target attainment was attenuated [OR = 1.25 (95% CI = 0.98, 1.59), p = 0.069]. Discussion: EDS is independently associated with failure of achieving glycemic and lipid targets, as well as a composite of all three treatment targets in obese individuals with T2D. Prospective studies are required to elucidate the causal relationship between EDS and metabolic control in obese T2D.