Sleep and Type 1 Diabetes Mellitus Management Among Children, Adolescents, and Emerging Young Adults: A Systematic Review

Exploring the effect of adhering to a healthy lifestyle pattern on glycemic control in adults with type 1 diabetes mellitus

BACKGROUND AND AIMS

Diet, physical activity, sleep and smoking have been individually associated with glycemic control (GC) in adults with type 1 diabetes mellitus (T1D). However, the combined effect of these factors has not been investigated. The aim of the present study was to examine the single and combined effects of lifestyle parameters on GC of people with T1D (PwT1D).

METHODS AND RESULTS

Dietary, physical activity and sleep habits were evaluated using validated questionnaires. Diet quality was assessed with two scores (MedDietScore and PURE Diet Score) and two healthy lifestyle indices (HLI) were constructed (MLI based on MedDietScore and PLI based on PURE score). The score of both HLI ranged from 0 to 12 with higher scores indicating greater adherence to the healthy lifestyle pattern. One hundred ninety-two adults [61 % female, median age 42 (34, 51) years] with T1D were included in the analysis. Good GC (defined as HbA1c<7 %) was observed in 31 % of study participants. Examining lifestyle components separately, only smoking was marginally inversely associated with good GC [odds ratio (OR): 0.48, (95 % confidence interval, CI:0.23-1.00; p = 0.050)]. Individuals with better GC had significantly higher HLI scores (both p < 0.05). After adjusting for age, sex, body mass index, wearing an insulin pump and using continuous glucose monitoring, one-unit increase in the PLI was associated with 16 % higher likelihood of good GC (OR:1.16, 95 % CI:1.01-1.35, p = 0.04) and a similar trend was recorded for MLI (p = 0.05).

CONCLUSION

Our results suggest that adherence to a healthy lifestyle, more so than single lifestyle parameters, is associated with better GC in PwT1D.

Nonpsychiatric Comorbidities in Pediatric Restless Leg Syndrome

Many medical disorders coexist with restless leg syndrome (RLS) and frequently have a bidirectional relationship. Specific examination of these relationships can help in more timely identification and intervention of RLS, as well as more comprehensive care delivery of the various related morbidities resulting in improved health outcomes, sleep, and quality of life. RLS in the pediatric population can be difficult to identify and frequently can be missed or mischaracterized as normal growth-related features. The goal is to enhance recognition of RLS, periodic limb movement disorder, and their medical comorbidities in a compressed time frame and launch a personalized treatment approach.

Chronotype, sleep, and glycemic control in children and adolescents with type 1 diabetes: a case-control study

OBJECTIVES

This study aimed to explore the relationships between sleep parameters, chronotype preferences, and glycemic control in children and adolescents with type 1 diabetes (T1DM), compared to healthy peers.

METHODS

A total of 96 children and adolescents with T1DM and 95 healthy controls aged 8-18 years participated in this case-control study. Anthropometric measurements were collected, and participants completed the Munich Chronotype Questionnaire and the Pittsburgh Sleep Quality Index (PSQI). Glycemic control was assessed using HbA1c levels.

RESULTS

Children with T1DM demonstrated significantly shorter sleep durations, poorer sleep quality, and a later chronotype compared to controls (p<0.05). Poor glycemic control (HbA1c>7.5 %) was observed in 72.9 % of the T1DM group, with 34.3 % exhibiting very poor control (HbA1c>9 %). Logistic regression identified poor sleep quality (PSQI score, OR: 1.47, p<0.001) and later chronotype (OR: 5.14, p<0.01) as independent predictors of poor glycemic control. Generalized linear modeling (GLM) further revealed significant associations between HbA1c levels, insulin dosage (p<0.001), and chronotype (p=0.090).

CONCLUSIONS

Late chronotype and poor sleep quality are closely linked to suboptimal glycemic control in pediatric T1DM populations. These findings underscore the importance of integrating sleep-focused strategies into routine diabetes management.

The effect of sleep quality on glucose variability among adolescents with type 1 diabetes in China: A multi-central temporal longitudinal association analysis

STUDY OBJECTIVES

High glucose variability is common among adolescents with type 1 diabetes mellitus (T1DM). On person level, poor sleep quality has been reported to be an important factor associated with high glucose variability among adolescents with T1DM. However, on day level, the effect of sleep quality on glucose variability remains unclear, limiting temporal adjustment of treatment regimens. This study aimed to concurrently explore associations between sleep quality and glucose variability at both day and person levels among Chinese adolescents with T1DM based on the 24-h Recursive Cycle model.

METHODS

A multi-center, seven-day, temporal longitudinal study was conducted among Chinese adolescents with T1DM. Glucose variability measures were calculated by fingertip blood glucose level at least seven times a day. Subjective sleep quality was measured by total sleep time, wake after sleep onset, number of awakenings, a score of sleep quality, sleep time, and wake time using a sleep diary. Objective sleep quality was assessed by Fitbit Inspire HR and included total sleep time, wake after sleep onset, and number of awakenings, rapid eye movement, light sleep time, deep sleep time, sleep time, wake time, sleep midpoint, and sleep efficiency. A multilevel linear regression model was performed to examine the associations between objective and subjective sleep quality and glucose variability at day and person levels. Gender, age, diabetes duration, complications documented within the preceding 6 months, HbA1c, and insulin pump therapy were controlled at person-level model.

RESULTS

A total of 51 adolescents with T1DM participated in this study, which included 357 records of data. Only 21.57 % (N = 12) of adolescents met the recommended sleep time of 480 min per night measured by Fitbit. About a quarter (N = 11) of adolescents had a coefficient of variation of blood glucose >36 %. At person level, there was no significant association between sleep quality and glucose variability (p > 0.05). Multilevel models found significant associations between sleep quality and glucose variability at day level. Lower score of subjective sleep quality was significantly associated with higher standard deviation of blood glucose (p < 0.05) in the next day. Less Fitbit-measured light sleep time was significantly associated with higher standard deviation of blood glucose, and postprandial of glycemic excursions in the next day (p < 0.05). More Fitbit-measured awakenings and less rapid eye movement were associated with higher postprandial glycemic excursions in the next day (p < 0.05).

CONCLUSION

Nearly 80 % of Chinese adolescents with T1DM did not meet the recommended amount of sleep for their age group. They experienced more wakes after sleep onset at night and poorer sleep quality than their subjective experience. According to the findings on temporal relationships, intervention components targeting reducing wakes after sleep onset and improving subjective sleep quality would reduce glucose variability over time among Chinese adolescents with T1DM.

The sleep health composite and chronotype among children and adolescents with type 1 diabetes compared to case-control peers without diabetes

STUDY OBJECTIVES

Our objectives were to compare sleep health composite dimensions and chronotype in children and adolescents with and without type 1 diabetes (T1D) and to explore the relationship between sleep and glycemic variability in T1D.

METHODS

The study comprised 84 participants with T1D aged between 6 to 18 years and age- and sex-matched controls. The sleep health composite was measured using actigraphy, sleep diaries, and self or parental reports. Sleep disturbance was evaluated using the DSM-5 Level 2 Sleep Disorders Scale Short Form. Chronotype was determined using the Children's Chronotype Questionnaire.

RESULTS

The median total sleep health composite score for both the T1D and control groups was 3.0 (3.0-4.0) (P = .485). Sleep quality was reported as good by 89.3% of participants with T1D and 96.4% of controls (P = .072). Objective data from actigraphy indicated poor sleep quality in 56% of participants with T1D and 59.5% of controls (P = .639). Additionally, 88% of participants with T1D and 84.5% of controls had inadequate total age-appropriate sleep duration (P = .501). Among participants with T1D, those with a stable glycemic variability (coefficient of variation < 36%) had an earlier midpoint sleep (P = .008).

CONCLUSIONS

Our study indicates that there are no significant differences in the sleep health composite and chronotype between children and adolescents with and without T1D. Although most participants reported good sleep quality, objective assessments indicated poor sleep quality. These findings suggest that children and adolescents may overestimate their sleep quality.

CLINICAL TRIAL REGISTRATION

Registry: ClinicalTrials.gov; Name: Sleep Patterns and Chronotype in Children With and Without Type 1 Diabetes; URL: https://clinicaltrials.gov/study/NCT06318611; Identifier: NCT06318611.

CITATION

İpar N, Boran P, Barış HE, et al. The sleep health composite and chronotype among children and adolescents with type 1 diabetes compared to case-control peers without diabetes. J Clin Sleep Med. 2025;21(5):825-834.

Developing a multicomponent intervention to increase glucose time in range in adolescents and young adults with type 1 diabetes: An optimisation trial to screen continuous glucose monitoring, sleep extension, healthier snacking and values-guided self-management intervention components

AIM

The study aimed to identify active intervention components to improve glucose sensor time in range (TIR; 70-180 mg/dL [3.9-10.0 mmol/L]) by ≥5 % among adolescents and young adults (13 to 20 yrs) with type 1 diabetes and above recommended glycated haemoglobin (HbA1c ≥ 7.5 % [≥ 58 mmol/mol]), regardless of current insulin therapy.

METHODS

The 6-week optimisation trial used a 24 factorial experiment to estimate the main effects and interactions of the following candidate intervention components on TIR: real-time continuous glucose monitoring (CGM) technology, sleep extension, healthier snacking support, and values-guided self-management. Twenty-one participants, mean (SD) age 16.1 (2.4) years, were randomised to one of 16 experimental conditions.

RESULTS

The main effects, as measured by the mean difference (95 % CI) in TIR from baseline to 4 weeks, were: CGM, 3.3 (-8.8, 15.4) percentage points; sleep extension, -7.2 (-19.0, 4.6) percentage points; snacking support, 0.9 (-11.8, 13.5) percentage points; values-guided self-management, 6.1 (-7.5, 19.7) percentage points.

CONCLUSIONS

The values-guided self-management was the only 'active' component. Conclusions about the less impactful intervention components are limited due to disruptions in research activities from the COVID-19 pandemic. Future work will address other candidate intervention components.

Screening for Sleep Disturbances in Children and Adolescents with Tics, Headache Disorders or Type 1 Diabetes

Sleep is essential for mental and physical well-being, yet it is often overlooked in children with medical conditions. To address this gap, we implemented screening for sleep disturbances to assess their prevalence in our clinics and identify potential intervention strategies. This cross-sectional study included children and adolescents aged 6-17 years with tics/Tourette syndrome, headaches, type 1 diabetes, and a healthy control group, who completed the validated Sleep Screening Questionnaire-Children and Adolescents (SSQ-CA).In total, 157 children with medical conditions and 117 healthy children completed the Sleep Screening Questionnaire-Children and Adolescents. Overall, 81.5% of the children with medical conditions reported a sleep disturbance compared with 70.9% in the healthy group (P = .28). Those with medical conditions reported poorer sleep quality (P < .001) and more awakenings (P = .047), as well as more frequent use of mobile/computer (P = .001) and television (P = .002) before bedtime compared with healthy children.We identified an alarmingly high prevalence of sleep disturbances in children with selected medical conditions, including more use of screens before bedtime, highlighting a significant yet frequently overlooked issue and possible target for intervention.

Interplay among sleep quality, dinner timing, and blood glucose control in users of advanced technologies: A study in a cohort of adults with type 1 diabetes

AIMS

To explore the interplay among sleep quality, dinner timing, and glycemic control in adults with type 1 diabetes (T1D) using advanced diabetes technologies.

METHODS

T1D adults on automated (AID, n = 122) or non-automated (CSII, n = 67) insulin delivery systems completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Two-week CGM-metrics, HbA1c, and post-dinner glucose control were compared by independent T-test in Good vs. Bad-sleepers (PSQI-score above 5) or in Early vs. Late-eaters (above median of the cohort's dinner time).

RESULTS

Time-below-range (TBR)70-54 (2.1 ± 2.0 vs. 1.3 ± 1.2 %), TBR54 (0.7 ± 1.0 vs. 0.2 ± 0.4 %), and coefficient of variation (34.4 ± 5.3 vs. 31.8 ± 5.2 %) were significantly higher in Bad-sleepers than Good-sleepers (p < 0.05 for all). Late-eaters, particularly among AID users, showed higher HbA1c and lower TBR70-54, and, after dinner, higher TAR180-250 and lower Time-in-range70-180 than Early-eaters (p < 0.05 for all). At multiple regression analysis, dinner time was a main predictor of HbA1c, and TBR54 a main predictor of sleep quality.

CONCLUSIONS

The rate of hypoglycemia and dinner timing are key factors affecting both sleep quality and glycemic control in adults with T1D. Addressing lifestyle habits, including dinner timing and fear of hypoglycemia, may still be needed in users of AID.

Around-the-clock: Caregiving at night for juveniles living with type 1 diabetes - a systematic review

Caring for children with type 1 diabetes (T1D) can require around-the-clock attention but there is little acknowledgment of the impact that nocturnal caregiving can have on caregivers in clinical care provision. This systematic review aimed to (1) explicate nocturnal caregiving practice (NCP) by identifying and synthesising peer-reviewed research to establish the prevalence and nature of NCP, (2) explore the impacts of NCP for caregivers, (3) evaluate the perceived value of technology for supporting NCP, and (4) examine potential solutions for mitigating NCP burden. In January, 2022, the databases CINAHL, MEDLINE, Web of Science, PsycINFO, Scopus and EMBASE were searched to identify peer-reviewed studies, published in English since 1997, which addressed NCP for juveniles with T1D. Quantitative, qualitative and mixed-methods studies were included. Risk of bias analysis was carried out using the quality assessment with diverse studies tool. Where possible, quantitative data were aggregated. Qualitative data was subjected to a narrative synthesis, using thematic analysis. Thirty-one studies met inclusion criteria, comprising 3,547 caregivers. 88% of caregivers engaged in NCP, though frequency was variable. Over 50% of participants (19-80%) failed to get adequate sleep and 54% reported poor sleep quality. Qualitative testimony detailed adverse impacts of NCP; exhaustion, difficulty making illness-management decisions, negative impacts on mood and physical health. Benefits from technology were equivocal. Evidence regarding predictors and associations for NCP, such as patient age, was contradictory. 83% of authors recommended that sleep be routinely addressed in clinic, which is not current practice. This review provides clear evidence that NCP in T1D is pervasive with significant negative impacts on caregivers. These secondary impacts of juvenile T1D need to be acknowledged so that care guidelines can be modified and psychosocial supports can be developed for use in clinical treatment environments.

Sleep Deficiency and Cardiometabolic Disease

Epidemiologic studies have demonstrated that short sleep duration is associated with an increased risk of cardio-metabolic health outcomes including cardiovascular disease mortality, coronary heart disease, type 2 diabetes mellitus, hypertension, and metabolic syndrome. Experimental sleep restriction studies have sought to explain these findings. This review describes the main evidence of these associations and possible mechanisms explaining them. Whether sleep extension reverses these now widely acknowledged adverse health effects and the feasibility of implementing such strategies on a public health level is discussed.

Sleep quality and glucose control in adults with type 1 diabetes during the seasonal daylight saving time shifts

AIM

There is a bidirectional relationship between glucose control and sleep quality and timing in type 1 diabetes (T1D). The aim of the study was to investigate the sleep quality and the glucose metrics in people with T1D at the seasonal clock adjustment.

METHODS

This observational study retrospectively compared the continuous glucose monitoring (CGM) derived metrics and sleep quality observed before (Time 0) and after (Time 1) transition in autumn and before (Time 2) and after (Time 3) transition in spring. We included adults with T1D, treated with CGM systems, who completed the Pittsburgh Sleep Quality Index questionnaire. The main outcome measure was the change in glucose monitoring indicator (GMI), time in range (TIR), time above range (TAR) and time below range.

RESULTS

Sixty-two participants showed no changes in sleep quality at time transitions. GMI values increased during both time transitions and the percentage of TIR decreased from Time 0 to Time 1 and from Time 2 to Time 3. The percentage of level 2 TAR increased during the observation.

CONCLUSIONS

At similar level of sleep quality, adults with T1D underwent the worsening of most of CGM-derived glucose control metrics during the transition time.

The effect of exercise on sleep habits of children with type 1 diabetic: a randomized clinical trial

BACKGROUND

Adequate sleep and exercise are important components of the human lifestyle. Paying attention to these two factors is very important to improve the condition of children with type 1 diabetes. Therefore, this study aimed to investigate the effect of exercise on sleep habits in children with type 1 diabetes.

MATERIAL & METHODS

62 children with type 1 diabetes participated in this clinical trial. They will be divided into the intervention group (31) and the control group (31). Sleep habits were measured using the Children's Sleep Habits Questionnaire (CSHQ). All children's parents completed the CSHQ. The intervention for the experimental group consisted of 8 weeks of regular exercise program. The exercise program was prepared as an educational video and provided to parents. Paired sample t-test and ANCOVA test were used with SPSS 23.

RESULTS

62 children with an average age of 9.32 ± 2.02 were studied. Fifty-four and eight% of the children were girls and the rest were boys. The analysis of the variance test showed a significant difference (F = 144.72, P ≤ 0.01) between the average score of the sleep habits of the control group (62.45 ± 5.12) and the experimental group (47.06 ± 4.39).

CONCLUSION

Sleep habits in the experimental group improved after 8 weeks of exercise training using educational videos. Exercise as a non-pharmacological treatment is an effective way to manage diabetes and improve sleep quality in diabetic children.

American Diabetes Association Professional Practice Committee, ElSayed NA, Aleppo G, Bannuru RR, Beverly EA, Bruemmer D, Collins BS, Darville A, Ekhlaspour L, Hassanein M, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2024

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Sleep Deficiency and Cardiometabolic Disease

Epidemiologic studies have demonstrated that short sleep duration is associated with an increased risk of cardio-metabolic health outcomes including cardiovascular disease mortality, coronary heart disease, type 2 diabetes mellitus, hypertension, and metabolic syndrome. Experimental sleep restriction studies have sought to explain these findings. This review describes the main evidence of these associations and possible mechanisms explaining them. Whether sleep extension reverses these now widely acknowledged adverse health effects and the feasibility of implementing such strategies on a public health level is discussed.

Associations between sleep characteristics and glycemic variability in youth with type 1 diabetes

OBJECTIVE

This study aimed to determine sleep characteristics and their associations with glycemic variability in youth with type 1 diabetes (T1D).

MATERIAL AND METHODS

This cross-sectional study conducted at two pediatric diabetes centers in Istanbul, Turkey, included 84 children with T1D (mean age 10.5 years). Sleep characteristics and glycemic variability were determined by actigraphy, DSM-5 Level 2-Sleep Disturbance Scale Short Form and continuous glucose monitoring. Circadian preference was evaluated by the Children's Chronotype Questionnaire. Sleep disturbances were assessed by the. The sleep quality was determined by actigraphy-derived sleep measures.

RESULTS

Eighty-eight percent of participants had insufficient age-appropriate total sleep time (TST) (<9 h for 6-13-year-olds and <8 h for 14-17-year-olds). Chronotype was classified as intermediate in 50%, evening in 45.2%, and morning in 4.8%. A higher chronotype score indicating a stronger eveningness preference was associated with more time spent in hypoglycemia (β = 0.433, p = 0.002). On nights when participants had lower sleep efficiency and longer sleep onset latency, they had significantly higher overnight glycemic variability (β = -0.343, p = 0.016, β = 0.129, p = 0.017, respectively). Prolonged nocturnal wake duration was significantly associated with more time spent in daytime hypoglycemia (β = 0.037, p = 0.046) and higher overnight glycemic variability (J index, β = 0.300, p = 0.015). The associations between TST and glycemic variability indices were not significant.

CONCLUSIONS

Sleep quality rather than TST was significantly associated with glycemic variability in children with T1D. Eveningness preference might contribute to an increased risk of hypoglycemia. Addressing sleep patterns and chronotypes can be crucial in management plans for youth with T1D.

Impact of Sleep and Activity on Glycemic Control and Quality of Life in Haitian Children and Youth with Type 1 Diabetes

Background

Sleep and physical activity affect overall health. In youth with type 1 diabetes (T1DM), they may improve glycemic control. Data from low-income countries are lacking.

Objective

To describe sleep and activity in Haitian children and youth with T1DM, and examine their impact on glycemic control, health-related quality of life (HRQL), and life satisfaction (LS).

Methods

This cross-sectional study in Haiti included people with T1DM aged 8-25 years. Wristbands (Mi Band 3) tracked activity (step count and activity time) and sleep (sleep duration, light sleep, and deep sleep). The Diabetes Quality of Life in Youth (DQOLY) questionnaire was used to evaluate HRQL and LS. Point-of-care (POC) hemoglobin A1c values were recorded. Linear regression was used to assess the relationship between sleep, activity, HbA1c, HRQL, and LS.

Results

We included 66 participants (59% female, mean age 17.8 ± 4.8 years, mean diabetes duration 3.7 ± 3.4 years, and mean BMI Z-score -0.86 ± 1.1). Mean HRQL was 63/100, and mean LS was 65/100. Mean HbA1c was 11.3%. Maximum HbA1c measure was 14% on the POC machine, and 23 participants (35%) had HbA1c recorded as 14%. Mean daily step count was 7,508 ± 3,087, and mean sleep duration was 7 h31 ± 1 h17. When excluding participants with HbA1c ≥ 14%, shorter sleep duration was significantly associated with higher HbA1c (p = 0.024). Sleep duration and step count were not associated with HRQL or LS.

Conclusions

Children and youth with T1DM in Haiti have poor glycemic control and low HRQL and LS. Their sleep and activity habits are similar to peers. While activity did not affect HbA1c, HRQL, or LS, shorter sleep duration was associated with higher HbA1c in participants with HbA1c < 14%. Prospective studies with larger sample sizes are needed to validate our findings.

Factors Affecting Depression and Its Relation to Sleep Quality among Parents of Type 1 Diabetes Patients

This study investigated factors affecting depression (CES-D) among parents of patients with type-1 diabetes mellitus (T1DM), a chronic disease that requires constant management. A complex set of factors influence depression in parents and thus requires further research. This is a cross-sectional descriptive study. A survey on related variables was conducted on 217 parents of patients with T1DM. The collected data were analyzed using the PASW Statistics program, and factors influencing participants’ depression were identified through stepwise multiple regression. The results show that three variables exerted a significant effect on depression (source of information, resilience–personal competence, and Pittsburgh sleep quality index score), and all the variables explained a majority of the variance in depression. The results indicate that the parents of patients with T1DM were less depressed when the source of information was personal, when their resilience–personal competence was high, and when their Pittsburgh sleep quality index (PSQI) score was low. Interventions targeting parents of patients with T1DM should be performed with positive information on how to overcome diabetes in their children, increase resilience–personal competence, and increase sleep quality.

Impact of 6 months' Use of Intermittently Scanned Continuous Glucose Monitoring on Habitual Sleep Patterns and Sleep Quality in Adolescents and Young Adults with Type 1 Diabetes and High-Risk HbA1c

Background

The bidirectional relationship between sleep and blood glucose levels may particularly affect adolescents and young adults (AYA), who are more likely to experience less healthy glycemic outcomes and more disrupted sleep patterns. To date, few data exist describing the impact of intermittently scanned continuous glucose monitoring (isCGM) on habitual sleep patterns and sleep quality in AYA with type 1 diabetes (T1D).

Objective

To evaluate the impact of 6-month use of isCGM on habitual sleep and wake timing, sleep duration, frequency, and duration of night-time awakenings, sleep efficiency, and perceived sleep quality in young people with T1D and HbA1c ≥ 75 mmol/mol. Participants. The study recruited 64 participants aged 13-20 years (mean 16.6 ± 2.1), 48% female, diabetes duration 7.5 ± 3.8 years, 41% Māori or Pasifika, and a mean HbA1c 96.0 ± 18.0 mmol/mol [10.9 ± 3.8%]; 33 were allocated to an isCGM plus self-monitoring blood glucose [SMBG] intervention, and 31 were allocated to the SMBG control group.

Methods

Participants completed 7-day actigraphy measures and the Pittsburgh Sleep Quality Index questionnaire at the baseline and at 6 months. Regression analyses were used to model between-group comparisons, adjusted for baseline sleep measures.

Results

At 6 months, subjective measures for overall sleep quality, latency, duration, efficiency, night-time disturbances, use of sleep medications, and daytime dysfunction were similar between the groups. Regression analyses of actigraphy found no significant differences in objectively measured sleep timing and duration across the week after adjusting for age, the period of the school year, and baseline sleep values.

Conclusions

The use of first-generation isCGM in addition to finger-prick testing did not impact objective or subjective sleep measures in AYA with T1D, elevated HbA1c, and highly variable sleep patterns. Research using alternative interventions for improving glycemic outcomes and habitual sleep-wake timing, duration, and perceived sleep quality is warranted in this population group.

Cognitive Behavioral Sleep Self-Management Intervention for Young Adults With Type 1 Diabetes (NCT04975230)

The purpose of this study was to explore perceptions of the first dose of a cognitive behavioral sleep self-management intervention (CB-sleep) among young adults aged 18 to 25 years with type 1 diabetes (T1D). We used a qualitative descriptive approach to conduct in-depth semi-structured focused interviews with a purposive sample of 16 young adults with T1D, transitioning from adolescence to early adulthood. Interviews were audio-recorded, transcribed verbatim, and analyzed using qualitative content analysis. Participants described their sleep knowledge (previous, new, and additional), sleep health goals, along with barriers and facilitators of the CB-sleep intervention. Based on these results, we suggest CB-sleep is a useful modality with the potential to support sleep self-management in young adults with T1D during this complex life transition. Furthermore, CB-sleep could be incorporated into an existing diabetes self-management education and support program after pilot testing and determining efficacy to improve sleep and glycemic health.

24-Hour Movement Behaviours (Physical Activity, Sedentary Behaviour and Sleep) Association with Glycaemic Control and Psychosocial Outcomes in Adolescents with Type 1 Diabetes: A Systematic Review of Quantitative and Qualitative Studies

Type 1 Diabetes (T1D) is a condition requiring 24-hour management. The way in which an individual combines their 24-hour movement behaviours (24-h MBs), which is comprised of physical activity (PA), sedentary behaviour (SB), and sleep, throughout the day can have a significant impact on physical and mental health. This mixed methods systematic review aimed to investigate 24-h MBs' relationship with glycaemic control and psychosocial outcomes in adolescents (11-18 years) with T1D. Ten databases were searched for quantitative and qualitative English language articles reporting at least one of the behaviours and their relationship with outcomes. There were no restrictions on article publication dates or study design. Articles were subjected to title and abstract screening, full text screening, data extraction and quality assessment. Data were summarised narratively, and a meta-analysis was conducted where possible. From 9922 studies, 84 were included for data extraction (quantitative (n = 76), qualitative (n = 8)). Meta-analyses revealed a significant favourable association between PA and HbA1c (-0.22 [95% CI: -0.35, -0.08; I² = 92.7%; p = 0.001). SB had an insignificant unfavourable association with HbA1c (0.12 [95% CI: -0.06, 0.28; I² = 86.1%; p = 0.07]) and sleep had an insignificant favourable association (-0.03 [95% CI: -0.21, 0.15; I² = 65.9%; p = 0.34]). Importantly, no study investigated how combinations of behaviours collectively interacted and impacted on outcomes.

Associated factors with depression and sleep quality in T1DM patients: a cross-sectional descriptive study

BACKGROUND

Individuals with type 1 diabetes (T1DM) may experience sleep problems, usually due to low blood sugar levels during sleep or performance of blood sugar management (e.g., blood sugar monitoring). This study aimed to identify the disease-related characteristics, psychosocial aspects, and related factors underlying sleep quality in patients with T1DM.

METHODS

This study employed a descriptive research design. The participants were 159 individuals with T1DM who completed online questionnaires. The data were analyzed using descriptive statistics, correlations, and multiple regression analyses.

RESULTS

The average score for depression in T1DM patients was 23.77 (SD 5.31), and sleep quality received a score of 4.58 (SD 3.22). Depression was positively correlated with sleep quality and negatively correlated with the total resilience score. The factors linked to depression in T1DM patients were duration of disease, sleep latency, sleep duration, sleep disturbance, and resilience-acceptance of self and life sub-factors, with an explanatory power of 44.4% for the depression variance. The associated factors with sleep quality in T1DM patients were complications, resilience-personal competence sub-factors, and depression, with an explanatory power of 37.4% for sleep quality variance.

CONCLUSIONS

The results of this study suggest that to improve sleep quality in patients with T1DM, it is necessary to develop and support disease management to prevent complications and implement interventions for improving resilience and reducing negative emotions such as depression.

5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2023

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Sleep and Circadian Rhythm Disturbances in Diabetes: A Narrative Review

Sleep and circadian rhythm disturbances are less-known risk factors for the development and suboptimal outcomes of diabetes. The goal of this narrative review is to highlight the importance of sleep and circadian rhythm disturbances in the development and outcomes of type 1 diabetes (T1D) and type 2 diabetes (T2D), assess current treatment options and the possible mediating mechanisms. We performed a literature search using PubMed and selected relevant English and Dutch papers. Disturbances of sleep and circadian rhythm are common in people with diabetes. They are associated with an increased risk of developing T2D as well as with suboptimal diabetes outcomes (including higher HbA1c levels and reduced quality of life) for T1D and T2D. Preliminary data suggest that treatment of sleep and circadian rhythm disturbances could improve diabetes outcomes in people with T1D and T2D. Finally, the association with medical parameters appears to be mediated by disturbance in hormones, and by suboptimal self-care including forgetting or postponing glucose monitoring or medication use as well as higher consumption of high fat/high sugary foods. Diabetes may also disturb sleep, for example through nocturnal hypoglycemia and nocturia. We concluded that sleep and circadian rhythm disturbances are closely linked with diabetes. More attention to sleep in regular diabetes care is warranted, while further research is needed on treatment of sleep and circadian rhythm disturbances in the prevention of diabetes and its suboptimal outcomes.

Corresponding risk factors between cognitive impairment and type 1 diabetes mellitus: a narrative review

Type 1 diabetes mellitus (T1DM) is a type of diabetes caused by the destruction of pancreatic β cells and the absolute lack of insulin secretion. T1DM usually starts in adolescence or develops directly as a severe disease state of ketoacidosis. T1DM and its complications make many people suffer and have psychological problems, which make us have to pay more attention to the prevention and early control of T1DM. Cognitive impairment (CI) is one of the major complications of T1DM. It can further develop into Alzheimer's disease, which can seriously affect the quality of life of the elderly. Furthermore, the relationship between T1DM and CI is unclear. Hence, we conducted a narrative review of the existing literature through a PubMed search. We summarized some risk factors that may be associated with the cognitive changes in T1DM patients, including onset age and duration, education and gender, glycemic states, microvascular complications, glycemic control, neuropsychology and emotion, intestinal flora, dyslipidemia, sleep quality. We aimed to provide some content related to CI in T1DM, and hoped that it could play a role in early prediction and treatment to reduce the prevalence.

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Corresponding risk factors between cognitive impairment and type 1 diabetes mellitus.

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Duration and age; Education and gender and Glycemic states.

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Diabetic ketoacidosis; Microvascular complications and Glycemic control–HbA1c.

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Neuropsychology and emotion; Intestinal flora; Dyslipidemia and Sleep Quality.

Sleep Deficiency and Cardiometabolic Disease

Epidemiologic studies have demonstrated that short sleep duration is associated with an increased risk of cardio-metabolic health outcomes including cardiovascular disease mortality, coronary heart disease, type 2 diabetes mellitus, hypertension, and metabolic syndrome. Experimental sleep restriction studies have sought to explain these findings. This review describes the main evidence of these associations and possible mechanisms explaining them. Whether sleep extension reverses these now widely acknowledged adverse health effects and the feasibility of implementing such strategies on a public health level is discussed.

Impact of Coronavirus Disease 2019 Outbreak on Children and Adolescents with Type 1 Diabetes Mellitus

BACKGROUND

This study aimed to investigate the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on daily routines and health of patients with type 1 diabetes mellitus (T1DM).

STUDY DESIGN

A cross-sectional study.

METHODS

This study included 98 children and adolescents with type 1 diabetes who were regularly followed up in the Endocrinology outpatient clinic of Besat Hospital, Hamadan, Iran, in 2020. The primary measurements included body mass index, glycemic control, number of hypoglycemic events, number of hospitalizations, as well as bedtime and availability of insulin six months pre and post COVID-19 outbreak. The obtained data were analyzed in SPSS software (version 16). A p-value less than 0.05 was considered statistically significant.

RESULTS

Out of 98 participants (mean±SD age: 13.5±49), 51% of the cases were male, and %81.6 of the patients were urban residents. Furthermore, most participants (43.9%) were in the age group of 11-15 years, and the mean±SD duration of diabetes was 4.64±3.31 years. In addition, 2.04% of the participants developed COVID-19. There was a statistically significant difference among average duration of night sleep (P<0.001), bedtime (P<0.001), time of waking up (P<0.001), amount of insulin intake (P=0.003), daily exercise (P<0.001), and availability of the insulin (P<0.001) before and during COVID-19 crisis. The frequencies of hospitalizations and hypoglycemic events were lower after the COVID-19 outbreak (P=0.005 and P=0.034, respectively). Morning insulin dose was omitted in 22.2% of participants. No differences were found between hemoglobin A1c and daytime sleep pre and post COVID-19 outbreak.

CONCLUSIONS

The key challenges due to COVID-19 pandemic restrictions for Iranian T1DM patients were the need to take more insulin, lower physical activity, non-availability of insulin, and missed morning insulin dose. However, it is worth mentioning that the patients' blood glucose control did not worsen in this period.