Daily Association Between Sleep And Glycemic Variability In Adolescents With Type 1 Diabetes Based On Model Of Recursive Cycle

BackgroundThe glycemic control of adolescents with type 1 diabetes(T1DM)is poor,and is influenced by many factors.The model of recursive cycle reported that sleep was associated with blood glucose levels.The association between sleep and recent glycemic control has been reported,while the impact of daily sleep on glycemic variability in adolescents with T1 DM has rarely been reported.Thus,it’s hard to provide suggestions for glycemic control in children from the perspective of improving sleep.Objective(1)To describe the status of recent and daily sleep,glycemic control and within-day daily glycemic variability in Chinese adolescents with T1DM;(2)To explore the associations between recent sleep characteristics and glycemic control in adolescents with T1DM;(3)To determine the day level(within-person)and person level(between-persons)associations between daily sleep characteristics and within-day daily glycemic variability in adolescents with T1 DM according to the model of recursive cycle.MethodA longitudinal study was conducted from February 2021 to February2022.The adolescents with T1 DM were recruited from the Second Xiangya Hospital of Central South University and the First Affiliated Hospital of Henan University of Science and Technology.At baseline,a basic information table,the Adolescent Sleep-Awake Scale,and the Epworth sleepiness scale were used to collect the recent sleep characteristics(sleep quality and daytime sleepiness)and glycemic control of adolescents.The fingertip blood glucose monitor,Fitbit HR,and sleep diary were distributed to collect the daily sleep characters and blood glucose level for 7 days.Descriptive statistics were computed by SPSS 23.0 to describe the recent and daily sleep characteristics,glycemic control,and the within-day daily glycemic variability in adolescents with T1 DM.One‐way ANOVA was used to explore the associations between recent sleep characteristics and glycemic control.A multilevel model was performed by MPlus 7.4 to examine the effects of daily sleep characteristics on within-day daily glycemic variability at both the day and person level.P values of < 0.05 were used in establishing statistical significance.Results(1)Of the 37 adolescents who were recruited,31(83.8%)completed all measurements over one week.The mean age of the participants was15.42 ± 2.17 years,with 58.1%(n = 18)were male.The mean duration was 40.73 ± 32.48 months.45.2%(n = 14)of the participants were treated with the insulin pump.(2)As for recent sleep,the participants’ mean scores for five sub-scales of the Adolescent Sleep Wake Scale(going to bed,falling asleep,maintaining sleep,reinitiating sleep,and return to wakefulness)were 17.80 ± 3.37,25.37 ± 3.76,27.39 ± 3.69,29.67 ± 4.33,and 17.19 ±4.56,respectively.The mean score of Epworth sleepiness scale was 6.54± 3.07,and 48.4%(n = 15)of the participants had a score of more than 6.As for objective daily sleep,the mean sleep time and mean wake time after sleep onset were 497.21 ± 79.85 minutes and 7.20 ± 16.47 minutes,respectively.The mean score of sleep quality was 4.03 ± 0.49.As for subjective daily sleep,the mean sleep time was 438.63 ±70.56 minutes.The mean wake time after sleep onset and frequency of wake after sleep onset were 45.60 ± 20.13 minutes and 22.56 ± 11.25,respectively.The mean bedtime was 482.81 ± 78.85 minutes,and the mean sleep efficacy was 0.90 ± 0.03.(3)As for glycemic control,the mean Hemoglobin A1c(Hb A1c)was 8.62 ± 2.01%,and 74.2% of the participants had Hb A1 c more than7.5%.As for within-day daily glycemic variability,the mean coefficient of variation(CV)was 30.62 ± 9.42%,and 22.6% of the participants had CV more than 36%.The mean standard deviation of blood glucose(SDBG)was 2.42 ± 0.89 mmol/L,and 19.4% of the participants had SDBG less than 2.0mmol/L.The mean postprandial of glycemic excursions(PPGE)was 2.73 ± 0.99 mmol/L,and 71.0% of the participants had PPGE more than 2.2 mmol/L.The mean daily mean blood glucose(MBG)was 7.94 ±1.49 mmol/L.(4)No statistically significant associations were found among recent sleep(sleep quality and daytime sleepiness)in terms of glycemic control(Hb A1c)(P > 0.05).(5)At the day level,longer subjective wake time after sleep onset was related to higher PPGE at the day level(P = 0.002).There were no significant associations between total sleep time,objective total sleep time,wake time after sleep onset,the frequency of wake after sleep onset,bedtime,sleep efficacy,and within-day daily glycemic variability(CV,SDBG,PPGE and MBG)(P > 0.05).At the person level,longer subjective and objective wake time after sleep onset were related to higher MBG(P = 0.045,P = 0.031).There were no significant associations between subjective total sleep time,objective total sleep time,the frequency of wake after sleep onset,bedtime,sleep efficacy,and within-day daily glycemic variability(CV,SDBG,PPGE and MBG)(P > 0.05).Conclusions(1)The recent sleep quality of Chinese adolescent T1 DM children was poor,and nearly half of the adolescents had daytime sleepiness.Daily sleep problems(e.g.,sleep disruption,wake time after sleep onset)were prominent.Healthcare providers should pay particular attention to the sleep of adolescents with T1 DM.Nearly three-quarters of the adolescents with T1 DM did not reach the target level of glycemic control.Besides,the within-day daily glycemic variability among Chinese adolescents with T1 DM is alarming in China.Nearly one-third of the adolescents with T1 DM had a high CV,80.6% with SDBG and 71.0% with PPGE were higher than the normal level.Medical staff should pay attention to the assessment of glycemic variability,which contributes to better and simpler management of T1 DM.(2)The associations between sleep quality,daytime sleepiness and glycemic control were not found in our study.After controlling confounding factors,more studies with larger sample sizes are needed to explore the associations further.(3)Longer wake time after sleep onset was associated with higher PPGE and MBG.Interventions aimed at decreasing wake time after sleep onset,and within-day daily glycemic variability in adolescents with T1 DM are needed.