Sleep-related symptoms of midlife women with and without type 2 diabetes mellitus

Association of serum 25-hydroxyvitamin D with sleep disorders in individuals with prediabetes and diabetes: a prospective cohort study

Background

Sleep disorders are common globally and are linked to various adverse health outcomes, including cardiovascular disease, type 2 diabetes, and mental health conditions. Emerging evidence suggests a potential role of serum 25-hydroxyvitamin D (25(OH)D) in regulating sleep. Individuals with prediabetes and diabetes are at an increased risk of both vitamin D deficiency and sleep disorders, yet the relationship between these factors remains insufficiently studied. Utilizing data from the UK Biobank, this study aims to investigate the association between serum 25(OH)D concentrations and the risk of sleep disorders in individuals with prediabetes and diabetes.

Methods

We conducted a cross-sectional study of 81,533 participants (mean age 59.6 [SD 7.1] years, comprising 41,275 males [50.6%] and 40,278 females [49.4%]) from the UK Biobank, followed by a prospective study of 80,546 participants (mean age 59.6 [SD 7.1] years, comprising 40,513 males [50.3%] and 40,033 females [49.7%]) within the same cohort, focusing on individuals with prediabetes and diabetes. Baseline serum 25(OH)D concentrations were categorized into four groups: severe deficiency (<25.0 nmol/L), moderate deficiency (25.0-50.0 nmol/L), insufficiency (50.0-75.0 nmol/L), and sufficiency (≥75.0 nmol/L). Multivariable logistic regression and Cox proportional hazards models were used, adjusting for demographic, lifestyle, and health-related confounders.

Results

Over an average follow-up of 12.8 years, we documented 2,704 cases of sleep disorders and found that higher serum 25(OH)D concentrations were significantly associated with reduced sleep disorder risk. In fully adjusted models, sufficient serum 25(OH)D concentrations reduced sleep disorder risk by 48% in prediabetes (HR = 0.52; 95% CI: 0.41-0.65) and 52% in diabetes (HR = 0.48; 95% CI: 0.34-0.67). Subgroup analysis found that adequate vitamin D concentrations were associated with improved sleep health especially in people ≤60 years of age, women, BMI≥30kg/m², and those who had never smoked.

Conclusion

This study provides strong evidence that higher serum 25(OH)D concentrations are associated with a reduced risk of sleep disorders in individuals with prediabetes and diabetes. These findings suggest that maintaining adequate vitamin D concentrations may offer a potential strategy to improve sleep health in this population.

Type 2 Diabetes in Women: Differences and Difficulties

BACKGROUND

Lifestyle modification, along with medication, has improved the quality of life of patients with type 2 diabetes (T2D), but the treatment of diabetes in women still lacks a gender-centric approach.

METHODS

Expert opinions to improve diabetes management in women were collated from the open discussion forum organized by the sixth Jothydev's Professional Education Forum Diabetes Convention, which included global diabetes care experts and the general public. The review is also based on the studies published in electronic databases such as PubMed and Google Scholar that discussed the problems and challenges faced by the Indian diabetes care sector in treating women with diabetes.

RESULTS

The complex interplay of biological, socioeconomic, psychosocial, and physiological factors in women with type 2 diabetes has not been well addressed to date. Biological factors such as neurohumoral pathways, sex hormones, genetic predisposition as well as gender-based environmental and behavioural differences must be considered for modern personalized diabetes treatment. Most importantly, pregnant women with diabetes deserve special attention. This vulnerable phase has a marked impact on the future health of both the mother and the offspring.

CONCLUSION

The review provides an overview of the challenges and issues that exist in the clinical management of diabetes and its complications among women in India. Women-centric clinical approaches should be encouraged for the effective management of diabetes in Indian women.

Menopause and sleep disorders

Women are likely to suffer from sleep disorders more in comparison to men during menopause and with advancing age. The incidence of sleep disorders ranges from 16% to 47% at peri-menopause and 35%–60% at postmenopause. Insomnia with or without associated anxiety or low lying depression and Mood disorder is most common associated manifestations. Sleep disorders and insomnia largely remain a clinical diagnosis based on the subjective complaints of patients. Benzodiazepines remain the mainstay of the treatment in majority of the sleep disorders including chronic or acute insomnia. Treatment of associated anxiety, depression, or psychosis is most important. Tricyclic antidepressant, Selective Serotonin Reuptake Inhibitors (SSRI), Melatonin, Duloxetine, Fluoxetine, Imipramine, Nortriptyline or Amitriptyline and other drugs such as Eszopiclone, Escitalopram, Gabapentin, Quiteiapine, Citalopram, Mirtazapine followed by long-acting Melatonin and Ramelteon, also are very useful for the management of various sleep disorders. Hormone replacement therapy presently lacks concrete evidence to be used in menopausal women for sleep disorder. Sleep hygiene practices, self-hypnosis, meditation, and exercise play a very important role.