Type 2 diabetes and health-related quality of life among older Medicare beneficiaries: The mediating role of sleep

Abstract

ObjectiveTo examine mediating effects of sleep quality and duration on the association between T2D and QoL among Medicare beneficiaries 65+. MethodsData from the Medicare Health Outcome Survey (2015–2020) were used. The outcome was QoL (physical and mental health component-summary scores [PCS and MCS]) measured by the Veterans-Rand-12. The main predictor was diagnosed T2D. Mediators were sleep duration and sleep quality. The effect modifier was race/ethnicity. Structural Equation Modeling was used to estimate moderated-mediating effects of sleep quality and duration across race/ethnicity. ResultsOf the 746,400 Medicare beneficiaries, 26.7% had T2D, and mean age was 76 years (SD ± 6.9). Mean PCS score was 40 (SD ± 12.2), and mean MCS score was 54.0 (SD ± 10.2). Associations of T2D with PCS and MCS were negative and significant. For all racial/ethnic groups, those with T2D reported lower PCS. For White, Black, Asian, and Hispanic beneficiaries only, those with T2D reported lower MCS. The negative impact of T2D on PCS and MCS was mediated through sleep quality, especially very bad sleep quality. ConclusionImproving sleep may lead to improvement in QoL in elderly adults with T2D.