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Cardiovascular disease (CVD) is a major cause of morbidity and mortality in persons with type 1 diabetes (T1D). Despite control of known cardiovascular (CV) risk factors and better glycemic management, persons with T1D still face heightened CVD risk, suggesting additional contributing factors. Sleep has recently been recognized as a CV risk factor, however; the role of sleep in CVD specifically in T1D population has only started to emerge. Extensive evidence suggests that persons with T1D often encounter sleep disturbances. This review aims to comprehensively explore the relationship between sleep disturbances and CVD in T1D, and proposed possible mediators including glycemic control which has been studied more extensively, and less studied factors such as blood pressure, lipid metabolism, and weight management. Stress and self-care behaviors likely also play a role in the relationship between sleep disturbances and CVD. The evidence regarding sleep interventions in the context of T1D in mitigating these CV risk factors has recently been shown in early, small-scale studies. Sleep assessments should be a part of standard of care in persons with T1D. Further research should focus on understanding the impact and mechanistic pathways of sleep disturbances on CV risk, and developing T1D specific sleep interventions to reduce CVD burden in this population.
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Chronic kidney disease (CKD) is a complication of diabetes that affects circulating drug concentrations and elimination of drugs from the body. Multiple drugs may be prescribed for treatment of diabetes and co-morbidities, and CKD complicates the pharmacotherapy selection and dosing regimen. Characterizing variations in renal drug clearance using models requires large clinical datasets that are costly and time-consuming to collect. We propose a flexible approach to incorporate impaired renal clearance in pharmacokinetic (PK) models using descriptive statistics and secondary data with mechanistic models and PK first principles. Probability density functions were generated for various drug clearance mechanisms based on the degree of renal impairment and used to estimate the total clearance starting from glomerular filtration for metformin (MET) and dapagliflozin (DAPA). These estimates were integrated with PK models of MET and DAPA for simulations. MET renal clearance decreased proportionally with a reduction in estimated glomerular filtration rate (eGFR) and estimated net tubular transport rates. DAPA total clearance varied little with renal impairment and decreased proportionally to reported non-renal clearance rates. Net tubular transport rates were negative to partially account for low renal clearance compared with eGFR. The estimated clearance values and trends were consistent with MET and DAPA PK characteristics in the literature. Dose adjustment based on reduced clearance levels estimated correspondingly lower doses for MET and DAPA while maintaining desired dose exposure. Estimation of drug clearance rates using descriptive statistics and secondary data with mechanistic models and PK first principles improves modeling of CKD in diabetes and can guide treatment selection.
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Compuestos de Bencidrilo , Tasa de Filtración Glomerular , Glucósidos , Hipoglucemiantes , Metformina , Modelos Biológicos , Insuficiencia Renal Crónica , Compuestos de Bencidrilo/farmacocinética , Compuestos de Bencidrilo/administración & dosificación , Metformina/farmacocinética , Metformina/administración & dosificación , Glucósidos/farmacocinética , Glucósidos/administración & dosificación , Insuficiencia Renal Crónica/metabolismo , Insuficiencia Renal Crónica/tratamiento farmacológico , Humanos , Hipoglucemiantes/farmacocinética , Hipoglucemiantes/administración & dosificación , Inhibidores del Cotransportador de Sodio-Glucosa 2/farmacocinética , Inhibidores del Cotransportador de Sodio-Glucosa 2/administración & dosificación , Simulación por Computador , MasculinoRESUMEN
OBJECTIVE: The purpose of this study was to test the preliminary effectiveness of a cognitive behavioral therapy intervention (Fear Reduction Efficacy Evaluation [FREE]) designed to reduce fear of hypoglycemia in young adults with type 1 diabetes. The primary outcome was fear of hypoglycemia, secondary outcomes were A1C, and glycemic variability. METHODS: A randomized clinical trial was used to test an 8-week intervention (FREE) compared to an attention control (diabetes education) in 50 young adults with type 1 diabetes who experienced fear of hypoglycemia at baseline. All participants wore a continuous glucose monitor for the 8-week study period. Self-reported fear of hypoglycemia point-of-care A1C testing, continuous glucose monitor-derived glucose variability were measured at baseline, Week 8, and Week 12 (post-program). RESULTS: Compared to controls, those participating in the FREE intervention experienced a reduction in fear of hypoglycemia (SMD B = -8.52, p = 0.021), change in A1C (SMD B = 0.04, p = 0.841) and glycemic variability (glucose standard deviation SMD B = -2.5, p = 0.545) by the end of the intervention. This represented an 8.52% greater reduction in fear of hypoglycemia. CONCLUSION: A cognitive behavioral therapy intervention (FREE) resulted in improvements in fear of hypoglycemia. CLINICALTRIALS: govNCT03549104.
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Terapia Cognitivo-Conductual , Diabetes Mellitus Tipo 1 , Miedo , Estudios de Factibilidad , Hipoglucemia , Humanos , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 1/psicología , Diabetes Mellitus Tipo 1/sangre , Terapia Cognitivo-Conductual/métodos , Miedo/psicología , Hipoglucemia/prevención & control , Hipoglucemia/psicología , Hipoglucemia/terapia , Masculino , Femenino , Adulto , Adulto Joven , Hemoglobina Glucada/análisis , Glucemia , Automonitorización de la Glucosa Sanguínea , Resultado del Tratamiento , AdolescenteRESUMEN
BACKGROUND: Heart surgery is an effective intervention for managing heart disease, the leading cause of death globally. After surgery, physical activity is key to improving patients' quality of life and decreasing mortality, but patients are frequently physically inactive after heart surgery. OBJECTIVE: This cross-sectional pilot study aimed to examine how psychosocial and sleep factors influenced physical activity in patients after heart surgery. The mediating role of sleep factors between psychosocial factors and physical activity was also examined. METHODS: Thirty-three patients who had undergone heart surgery were recruited. Psychosocial and sleep factors and physical activity were measured using an online survey and a wrist-worn ActiGraph for 7 days and nights. RESULTS: The participants had heart surgery an average of about 7 years previously. They exceeded the recommended 150 minutes per week of moderate-intensity physical activity for Americans; however, 64% of them showed poor sleep quality (Pittsburgh Sleep Quality Index >5). Higher anxiety and depressive symptoms, lower self-efficacy, and greater sleep disturbances were associated with lower physical activity. Moreover, self-efficacy, sleep duration, sleep disturbance, sleep efficiency, and wake after sleep onset were predictors for physical activity. No mediating role of sleep factors was observed between psychosocial factors and physical activity. CONCLUSIONS: Psychosocial and sleep factors should be considered when developing and implementing physical activity strategies for patients after heart surgery. Researchers should examine the relationships among the study variables with larger samples of postsurgical cardiac patients during different periods after heart surgery.
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Procedimientos Quirúrgicos Cardíacos , Trastornos del Sueño-Vigilia , Humanos , Calidad de Vida , Estudios Transversales , Proyectos Piloto , Sueño , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Ejercicio Físico , Trastornos del Sueño-Vigilia/psicologíaRESUMEN
OBJECTIVE: Estimate the association between single (i.e., exclusive) use of a range of substances and sleep outcomes. PARTICIPANTS: College students participated in the 2015-2019 American College-Health Association-National College-Health Assessment survey. METHODS: Multivariable logistic and linear regressions were used. RESULTS: Single users of sedative, opioid, tobacco, and stimulant drugs were more likely to report a diagnosis of insomnia and other sleep disorder and indicated more days per week of negative sleep health outcomes compared not only to non-users of these substances but also polysubstance users. Single users of alcohol were significantly less likely to report a diagnosis of sleep disorder and indicated having had more days per week of positive sleep health outcomes compared to non-alcohol users and polysubstance users. However, those results are reversed for binge drinking. CONCLUSIONS: Support of programs addressing behaviors to reduce the high prevalence of psychoactive substance use and sleep disturbances in college youth is needed.
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AIMS/HYPOTHESIS: The aim of this study was to explore whether diabetic retinopathy is associated with alterations of the circadian system, and to examine the role of reduced intrinsically photosensitive retinal ganglion cell (ipRGC) function. METHODS: Participants with type 2 diabetes, with diabetic retinopathy (n=14) and without diabetic retinopathy (n=9) underwent 24 h blood sampling for melatonin and cortisol under controlled laboratory conditions. ipRGC function was inferred from the post-illumination pupil response (PIPR). Habitual sleep duration, efficiency and variability were assessed by actigraphy. RESULTS: Participants with diabetic retinopathy compared to participants without diabetic retinopathy had smaller PIPR (p=0.007), lower 24 h serum melatonin output (p=0.042) and greater day-to-day sleep variability (p=0.012). By contrast, 24 h cortisol profiles, sleep duration and efficiency were similar in both groups. Six individuals with diabetic retinopathy had no detectable dim-light melatonin onset. PIPR correlated with 24 h mean melatonin levels (r=0.555, p=0.007). CONCLUSIONS/INTERPRETATION: ipRCG dysfunction in diabetic retinopathy is associated with disruptions of the 24 h melatonin rhythm, suggesting circadian dysregulation in diabetic retinopathy.
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Ritmo Circadiano , Diabetes Mellitus Tipo 2 , Retinopatía Diabética , Melatonina , Células Ganglionares de la Retina , Humanos , Melatonina/sangre , Melatonina/metabolismo , Retinopatía Diabética/metabolismo , Retinopatía Diabética/sangre , Retinopatía Diabética/fisiopatología , Células Ganglionares de la Retina/metabolismo , Células Ganglionares de la Retina/patología , Masculino , Femenino , Estudios Transversales , Persona de Mediana Edad , Ritmo Circadiano/fisiología , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/fisiopatología , Anciano , Hidrocortisona/sangre , Hidrocortisona/metabolismo , Sueño/fisiología , AdultoRESUMEN
Most adults with type 1 diabetes (T1DM) are either overweight or obese. As such, dietary management is recommended as an adjunct to insulin treatment to improve glycemic control and facilitate weight loss in these patients. Time-restricted eating (TRE) is a form of intermittent fasting that offers a simplified approach to treating obesity in T1DM. TRE typically involves restricting eating to 6 to 10 h per day, with water and medications allowed outside the eating window. This review examines the efficacy of TRE and other fasting protocols in improving weight and glycemic control in patients with obesity and T1DM. This review will also evaluate the safety of these regimens and provide advice to clinicians on implementing intermittent fasting in T1DM.
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Diabetes Mellitus Tipo 1 , Ayuno , Humanos , Diabetes Mellitus Tipo 1/metabolismo , Diabetes Mellitus Tipo 1/terapia , Ayuno/fisiología , Obesidad/metabolismo , Obesidad/dietoterapiaRESUMEN
South Africans living in low socioeconomic areas have self-reported unusually long sleep durations (approximately 9-10 h). One hypothesis is that these long durations may be a compensatory response to poor sleep quality as a result of stressful environments. This study aimed to investigate whether fear of not being safe during sleep is associated with markers of sleep quality or duration in men and women. South Africans (n = 411, 25-50 y, 57% women) of African-origin living in an urban township, characterised by high crime and poverty rates, participated in this study. Participants are part of a larger longitudinal cohort study: Modelling the Epidemiologic Transition Study (METS)-Microbiome. Customised questions were used to assess the presence or absence of fears related to feeling safe during sleep, and the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index were used to assess daytime sleepiness, sleep quality and insomnia symptom severity respectively. Adjusted logistic regression models indicated that participants who reported fears related to safety during sleep were more likely to report poor sleep quality (PSQI > 5) compared to participants not reporting such fears and that this relationship was stronger among men than women. This is one of the first studies outside American or European populations to suggest that poor quality sleep is associated with fear of personal safety in low-SES South African adults.
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Trastornos del Inicio y del Mantenimiento del Sueño , Masculino , Adulto , Humanos , Femenino , Autoinforme , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Estudios Longitudinales , Sueño/fisiología , Miedo , Clase Social , Encuestas y CuestionariosRESUMEN
BACKGROUND: Maintaining physical activity is challenging after cardiac surgery. Postsurgical cardiac patients often experience sleep problems showing a reciprocal interaction with physical activity. As sleep and physical activity show day-to-day variations, their daily relationships need to be assessed. However, no studies have examined daily sleep-physical activity relationships in postsurgical cardiac patients. OBJECTIVES: This study aimed to examine the effects of daily sleep factors on daily physical activity after cardiac surgery. METHODS: Among 33 patients who underwent cardiac surgery at least 10 weeks earlier, 5 sleep and 4 physical activity variables were measured using a wrist-worn ActiGraph for 7 days. Mixed-effects models were applied for data analyses. RESULTS: Most participants were male (57.6 %), non-Hispanic whites (63.6 %) who had coronary artery bypass graft surgery (54.6 %). Participants averaged 60.8 ± 10.1 years of age and 85.7 ± 91.2 months since surgery. They slept for an average of 385.6 ± 74.6 min (6.4 ± 1.2 h). Among sleep factors, greater number of awakenings (NOA) predicted lower next-day sedentary time. Higher sleep efficiency (SE) was associated with lower next-day sedentary time when not controlling for covariates. Among the psychosocial, demographic, and clinical covariates, higher comorbidity index was associated with fewer kcals expended, less daily moderate-to-vigorous physical activity, and more daily sedentary time. CONCLUSIONS: Daily SE and NOA and individual health status, including comorbidity, should be assessed over time to support improvement of daily physical activity after cardiac surgery. Researchers should examine the relationship between NOA and next-day sedentary time with larger samples. Such research should address multiple psychosocial, demographic, and clinical factors and the potential mediating role of sleep.
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Ejercicio Físico , Sueño , Humanos , Masculino , Femenino , Conducta Sedentaria , Comorbilidad , Puente de Arteria CoronariaRESUMEN
Short sleep duration is associated with heightened cardiometabolic disease risk and has reached epidemic proportions among children, adolescents and adults. Potential mechanisms underlying this association are complex and multifaceted, including disturbances in circadian timing, food intake and appetitive hormones, brain regions linked to control of hedonic eating, physical activity, an altered microbiome and impaired insulin sensitivity. Sleep extension, or increasing total sleep duration, is an emerging and ecologically relevant intervention with significant potential to advance our understanding of the mechanisms underlying the association between short sleep duration and the risk of cardiometabolic disease. If effective, sleep extension interventions have potential to improve cardiometabolic health across the lifespan. Existing data show that sleep extension is feasible and might have potential cardiometabolic health benefits, although there are limitations that the field must overcome. Notably, most existing studies are short term (2-8 weeks), use different sleep extension strategies, analyse a wide array of cardiometabolic health outcomes in different populations and, frequently, lack adequate statistical power, thus limiting robust scientific conclusions. Overcoming these limitations will require fully powered, randomized studies conducted in people with habitual short sleep duration and existing cardiometabolic risk factors. Additionally, randomized controlled trials comparing different sleep extension strategies are essential to determine the most effective interventions. Ongoing and future research should focus on elucidating the potential cardiometabolic health benefits of sleep extension. Such studies have high potential to generate crucial knowledge with potential to improve health and quality of life for those struggling with short sleep duration.
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Diabetic retinopathy (DR) is one of the most prevalent microvascular diabetic complications. Poor sleep health and obstructive sleep apnea (OSA) are risk factors for diabetes and poor glycemic control. Recent studies have suggested associations between poor sleep health/OSA and DR. Furthermore, there have been suggestions of melatonin dysregulation in the context of DR. We conducted a systematic review and meta-analysis exploring the associations between multidimensional sleep health (duration, satisfaction, efficiency, timing/regularity and alertness), OSA and melatonin with DR. Forty-two studies were included. Long, but not short sleep, was significantly associated with DR, OR 1.41 (95%CI 1.21, 1.64). Poor sleep satisfaction was also significantly associated with DR, OR 2.04 (1.41, 2.94). Sleep efficiency and alertness were not associated with DR, while the evidence on timing/regularity was scant. Having OSA was significantly associated with having DR, OR 1.34 (1.07, 1.69). Further, those with DR had significantly lower melatonin/melatonin metabolite levels than those without DR, standardized mean difference -0.94 (-1.44, -0.44). We explored whether treating OSA with continuous positive airway pressure (CPAP) led to improvement in DR (five studies). The results were mixed among studies, but potential benefits were observed in some. This review highlights the association between poor multidimensional sleep health and DR.
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Retinopatía Diabética , Melatonina , Apnea Obstructiva del Sueño , Humanos , Apnea Obstructiva del Sueño/terapia , Apnea Obstructiva del Sueño/complicaciones , Presión de las Vías Aéreas Positiva Contínua , Factores de Riesgo , Calidad del Sueño , Sueño/fisiologíaRESUMEN
This study investigated the impact of comprehensive sleep patterns on glycaemic parameters and endothelial function in adolescents and young adults with type 1 diabetes (T1D). Thirty subjects with type 1 diabetes (aged 13-25) without chronic complications participated. For 1 week, glucose levels were monitored by real-time continuous glucose monitoring (CGM) and sleep was simultaneously assessed by actigraphy. Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Flow-mediated dilatation (FMD) measured endothelial function at the brachial artery. Insulin sensitivity was determined by calculated estimated glucose disposal rate (eGDR). Glycaemic control was assessed using haemoglobin A1C (HbA1C) levels. To address potential confounding by metabolic syndrome on the FMD results, three affected subjects were excluded from FMD correlation analyses. Participants with PSQI scores >5 had a lower %FMD compared with those with scores ≤5 (4.6 ± 3.7% vs. 7.6 ± 3.0%, p = 0.03). Multivariate analysis indicated that lower sleep efficiency and higher sleep duration variability were associated with higher HbA1C levels (ß = -0.076, 95%CI [-0.145, -0.008], p = 0.029; ß = 0.012, 95%CI [0.001, 0.023], p = 0.033). Irregular sleep timing and lower sleep efficiency were related to decreased insulin sensitivity (sleep midpoint irregularity ß = -1.581, 95%CI [-2.661, -0.502], p = 0.004, and sleep efficiency ß = 0.147, 95%CI [0.060, 0.235], p = 0.001). No significant associations were found between glycaemic parameters and FMD. Our study demonstrated that sleep irregularity in type 1 diabetes was associated with glycaemic control and insulin resistance, while poor subjective sleep quality was linked to endothelial dysfunction. Promoting healthy sleep habits, including consistent sleep timing could benefit metabolic and cardiovascular health in type 1 diabetes.
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This randomized controlled trial is aimed at assessing the efficacy of combining time-restricted eating (TRE) with behavioral economic (BE) interventions and comparing it to TRE alone and to the usual care for reducing fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), and other cardiometabolic risk factors among patients with impaired fasting glucose (IFG). Seventy-two IFG patients aged 18-65 years were randomly allocated for TRE with BE interventions (26 patients), TRE alone (24 patients), or usual care (22 patients). Mean FPG, HbA1c, and other cardiometabolic risk factors among the three groups were compared using a mixed-effect linear regression analysis. Mean body weight, FPG, HbA1c, fasting insulin, and lipid profiles did not significantly differ among the three groups. When considering only patients who were able to comply with the TRE protocol, the TRE group showed significantly lower mean FPG, HbA1c, and fasting insulin levels compared to the usual care group. Our results did not show significant differences in body weight, blood sugar, fasting insulin, or lipid profiles between TRE plus BE interventions, TRE alone, and usual care groups. However, TRE might be an effective intervention in lowering blood sugar levels for IFG patients who were able to adhere to the TRE protocol.
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Enfermedades Pancreáticas , Estado Prediabético , Humanos , Glucemia , Peso Corporal , Factores de Riesgo Cardiometabólico , Economía del Comportamiento , Ayuno , Hemoglobina Glucada , Insulina , Lípidos , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , AncianoRESUMEN
OBJECTIVE: Sleep and circadian disturbances emerge as novel factors influencing glycemic control in type 1 diabetes (T1D). We aimed to explore the associations among sleep, behavioral circadian parameters, self-care, and glycemic parameters in T1D. METHODS: Seventy-six non-shift-working adult T1D patients participated. Blinded 7-day continuous glucose monitoring (CGM) and hemoglobin A1C (A1C) were collected. Percentages of time-in-range (glucose levels 70-180 mg/dL) and glycemic variability (measured by the coefficient of variation [%CV]) were calculated from CGM. Sleep (duration and efficiency) was recorded using 7-day actigraphy. Variability (standard deviation) of midsleep time was used to represent sleep variability. Nonparametric behavioral circadian variables were derived from actigraphy activity recordings. Self-care was measured by diabetes self-management questionnaire-revised. Multiple regression analyses were performed to identify independent predictors of glycemic parameters. RESULTS: Median (interquartile range) age was 34.0 (27.2, 43.1) years, 48 (63.2%) were female, and median (interquartile range) A1C was 6.8% (6.2, 7.4). Sleep duration, efficiency, and nonparametric behavioral circadian variables were not associated with glycemic parameters. After adjusting for age, sex, insulin delivery mode/CGM use, and ethnicity, each hour increase in sleep variability was associated with 9.64% less time-in-range (B = -9.64, 95% confidence interval [-16.29, -2.99], p ≤ .001). A higher diabetes self-management questionnaire score was an independent predictor of lower A1C (B = -0.18, 95% confidence interval [-0.32, -0.04]). CONCLUSION: Greater sleep timing variability is independently associated with less time spent in the desirable glucose range in this T1D cohort. Reducing sleep timing variability could potentially lead to improved metabolic control and should be explored in future research. DATA AVAILABILITY STATEMENT: Data are available upon a reasonable request to the corresponding author.
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Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Adulto , Humanos , Femenino , Masculino , Diabetes Mellitus Tipo 1/complicaciones , Hemoglobina Glucada , Estudios Transversales , Glucemia/metabolismo , Automonitorización de la Glucosa Sanguínea , Sueño , Encuestas y Cuestionarios , GlucosaRESUMEN
Sleep irregularity and variability have been shown to be detrimental to cardiometabolic health. The present pilot study explored if higher day-to-day sleep irregularity and variability were associated with systemic inflammation, as assessed by high-sensitivity C-reactive protein, in type 2 diabetes. Thirty-five patients with type 2 diabetes (mean age 54.3 years, 54.3% female) who were not shift-workers participated. The presence of diabetic retinopathy was determined. The standard deviation of sleep duration and sleep midpoint across all recorded nights were used to quantify sleep variability and regularity, respectively, assessed by 14-day actigraphy. The presence and severity of sleep apnea were assessed using an overnight home monitor. Low-density lipoprotein, haemoglobin A1C and high-sensitivity C-reactive protein were collected. Multiple regression analysis using natural-log-transformed values was performed to establish an independent association between sleep variability and high-sensitivity C-reactive protein. Twenty-two (62.9%) patients had diabetic retinopathy. The median (interquartile range) of high-sensitivity C-reactive protein was 2.4 (1.4, 4.6) mgâ L-1 . Higher sleep variability was significantly associated with higher high-sensitivity C-reactive protein (r = 0.342, p = 0.044), as was haemoglobin A1C (r = 0.431, p = 0.010) and low-density lipoprotein (r = 0.379, p = 0.025), but not sleep regularity, sleep apnea severity or diabetic retinopathy. Multiple regression analysis showed that higher sleep variability (B = 0.907, p = 0.038) and higher HbA1c (B = 1.519, p = 0.035), but not low-density lipoprotein, contributed to higher high-sensitivity C-reactive protein. In conclusion, higher sleep variability in patients with type 2 diabetes who were not shift-workers was independently associated with higher systemic inflammation, conferring increased cardiovascular risk. Whether sleep interventions to reduce sleep variability can reduce systemic inflammation and improve cardiometabolic health should be investigated.
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Circadian abnormalities can adversely affect glucose metabolism. This study determined whether behavioral circadian parameters, as assessed by rest-activity rhythm, were predictors of glycemic control in patients with prediabetes. Seventy-nine patients with prediabetes participated. Nonparametric rest-activity rhythm parameters, sleep duration and efficiency were obtained from 7-d actigraphy recordings. Sleep-disordered breathing severity was assessed using a home sleep apnea test. Hemoglobin A1c (HbA1c) was obtained to evaluate glycemic control. The results revealed that shorter sleep duration, lower relative amplitude and higher L5 (average activity of the least active 5-h period) were associated with higher HbA1c, while other sleep variables were not related to HbA1c. Multiple stepwise regression analysis adjusting for age, sex, body mass index and sleep duration revealed that lower relative amplitude, but not L5, was independently associated with higher HbA1c (B = -0.027, p = 0.031). In summary, among patients with prediabetes, an abnormal circadian rhythm was associated with higher HbA1c, implying a greater risk of developing diabetes. These results support the role of circadian rhythmicity in glucose control among those with prediabetes.
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Estado Prediabético , Humanos , Hemoglobina Glucada , Ritmo Circadiano , Sueño , Descanso , Glucemia/metabolismoRESUMEN
Diabetes is highly prevalent and is associated with dietary behaviors. Time-restricted eating, which consolidates caloric intake to a shortened eating duration, has demonstrated improvement in metabolic health. Timing of eating could also impact metabolism. Our objective was to examine whether the timing of eating was associated with metabolic health independently of eating duration. Data (n = 7619) are from four cycles (2005-2012) of the National Health and Nutrition Examination Survey (NHANES), a nationally representative U.S. survey that included surveys, physical examinations, and dietary recalls. The primary exposures are eating duration and eating start time estimated from two non-consecutive dietary recalls. Primary outcomes were fasting glucose and estimated insulin resistance using the homeostatic model assessment method (HOMA-IR). The mean (95% CI) eating duration was 12.0 h (11.9-12.0) and the mean (95% CI) start time was 8:21 (8:15-8:26). Earlier eating start time was significantly associated with lower fasting glucose and estimated insulin resistance but eating interval duration was not. Every hour later that eating commenced was associated with approximately 0.6% higher glucose level and 3% higher HOMA-IR (both p < 0.001). In this cross-sectional study, earlier eating start time was associated with more favorable metabolic measures, indicating that meal timing is another important characteristic of dietary patterns that may influence metabolism.
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Resistencia a la Insulina , Humanos , Encuestas Nutricionales , Estudios Transversales , Glucemia/metabolismo , DietaRESUMEN
PURPOSE: The purpose of this study was to evaluate the feasibility and acceptability of a technology-assisted behavioral sleep intervention (Sleep-Opt-In) and to examine the effects of Sleep-Opt-In on sleep duration and regularity, glucose indices, and patient-reported outcomes. Short sleep duration and irregular sleep schedules are associated with reduced glycemic control and greater glycemic variability. METHODS: A randomized controlled parallel-arm pilot study was employed. Adults with type 1 diabetes (n = 14) were recruited from the Midwest and randomized 3:2 to the sleep-optimization (Sleep-Opt-In) or Healthy Living attention control group. Sleep-Opt-In was an 8-week, remotely delivered intervention consisting of digital lessons, sleep tracker, and weekly coaching phone calls by a trained sleep coach. Assessments of sleep (actigraphy), glucose (A1C, continuous glucose monitoring), and patient-reported outcomes (questionnaires for daytime sleepiness, fatigue, diabetes distress, and depressive mood) were completed at baseline and at completion of the intervention. RESULTS: Sleep-Opt-In was feasible and acceptable. Those in Sleep-Opt-In with objectively confirmed short or irregular sleep demonstrated an improvement in sleep regularity (25 minutes), reduced glycemic variability (3.2%), and improved time in range (6.9%) compared to the Healthy Living attention control group. Patient-reported outcomes improved only for the Sleep-Opt-In group. Fatigue and depressive mood improved compared to the control. CONCLUSIONS: Sleep-Opt-In is feasible, acceptable, and promising for further evaluation as a means to improve sleep duration or regularity in the population of people with type 1 diabetes.
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Diabetes Mellitus Tipo 1 , Humanos , Adulto , Diabetes Mellitus Tipo 1/complicaciones , Proyectos Piloto , Automonitorización de la Glucosa Sanguínea , Glucemia , Sueño , FatigaRESUMEN
STUDY OBJECTIVES: There is a complex interplay between obstructive sleep apnea (OSA) and type 2 diabetes. There are minimal data regarding the effects of treating OSA with positive airway pressure (PAP) therapy on outcomes and health care resource utilization (HCRU) in patients with OSA and type 2 diabetes. We investigated the impact of PAP adherence on HCRU and costs in this population. METHODS: A retrospective analysis was conducted with a cohort of OSA patient from a US administrative claims dataset linked to objective device data (AirView, ResMed Corp., San Diego, California). Propensity score matching was used to control for potential imbalance in baseline covariates between PAP-adherent and -nonadherent patients. Newly diagnosed patients with OSA aged ≥ 18 years with type 2 diabetes were included. PAP adherence was defined as meeting Centers for Medicare and Medicaid Services compliance criteria in all 8 90-day periods over 2 years. HCRU was based on the number of all-cause doctor visits, emergency room visits, inpatient hospitalizations, and PAP equipment and supplies. RESULTS: In years 1 and 2 of PAP therapy, HCRU was significantly lower in adherent vs nonadherent patients (number/patient for emergency room visits 0.68 ± 1.47 vs 0.99 ± 1.91 [year 1], 0.69 ± 1.43 vs 0.95 ± 1.89 [year 2]; for hospitalizations 0.16 ± 0.58 vs 0.22 ± 0.62 [year 1], 0.15 ± 0.51 vs 0.21 ± 0.74 [year 2]; all P < .001). Changes in estimated total 24-month payments were higher for nonadherent patients ($2,282, 95% confidence interval: $1,368, $3,205). CONCLUSIONS: Consistent use of PAP therapy over 2 years was associated with decreased HCRU in patients with OSA and type 2 diabetes, strongly suggesting a role for screening and treating OSA in type 2 diabetes. CITATION: Sterling KL, Cistulli PA, Linde-Zwirble W, et al. Association between positive airway pressure therapy adherence and health care resource utilization in patients with obstructive sleep apnea and type 2 diabetes in the United States. J Clin Sleep Med. 2023;19(3):563-571.
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Diabetes Mellitus Tipo 2 , Apnea Obstructiva del Sueño , Humanos , Anciano , Estados Unidos , Estudios Retrospectivos , Presión de las Vías Aéreas Positiva Contínua , Medicare , Apnea Obstructiva del Sueño/terapia , Cooperación del Paciente , Pacientes InternosRESUMEN
Stress and diabetes coexist in a vicious cycle. Different types of stress lead to diabetes, while diabetes itself is a major life stressor. This was the focus of the Chicago Biomedical Consortium's 19th annual symposium, "Stress and Human Health: Diabetes," in November 2022. There, researchers primarily from the Chicago area met to explore how different sources of stress - from the cells to the community - impact diabetes outcomes. Presenters discussed the consequences of stress arising from mutant proteins, obesity, sleep disturbances, environmental pollutants, COVID-19, and racial and socioeconomic disparities. This symposium showcased the latest diabetes research and highlighted promising new treatment approaches for mitigating stress in diabetes.