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Sleep: Why it’s Crucial for Teens with Diabetes

Nov 19, 2019
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Hira Gohar, Florida A&M University, College of Pharmacy, PharmD Candidate

This study covers the implications of sleep and its effect on behavioral and physiological implications in teens with type 1 diabetes.

Patients with type 1 diabetes are usually at an increased risk for developing comorbidities if they are not adherent to their suggested sleep schedule. The need for improved outcomes in diabetes has to start at the baseline level.  Patients with diabetes are at the highest risk for developing microvascular and macrovascular complications at a fast rate if their condition is not controlled – that is why health care providers need to step in and take control of this situation. Most adolescents get insufficient sleep that equates to less than the recommended 8 hours. Due to this, most teens with diabetes have poor adherence to their sleep schedule, thus worsening their chances of developing comorbid conditions.

In this randomized behavioral study, researchers proposed to create a sleep-promoting intervention that would help with sleep adherence in adolescent patients. To identify barriers and help to promote sleep adherence, they conducted interviews — three physicians who had specialties in sleep medicine, neurology, and pediatric psychology conducted this study. The sleep-promoting aspect of this study was to be confounded on limiting caffeine intake, creating an electronic device use curfew, positive bedtime routines, and also addressing the fear of hypoglycemia with adolescent patients who have type 1 diabetes.

Sleep has a major effect on our behavioral and physiological state of well being. There is a strong correlation between the lack of sleep and diabetes outcomes, specifically on the impact of sleep on insulin sensitivity, behavior, and mood. Researchers believe that this interventional study would be able to promote proper sleep habits and better care of patients with type 1 diabetes. Patients with type 1 diabetes overall experience higher rates of sleep disturbance than those without diabetes. Sleep disturbances can have dire effects on glycemic control, cognitive, and behavioral functioning. Inconsistent sleep timing has shown to have negative implications in the body, such as poor glycemic control and adherence to treatment.

The primary outcome measures included: sleep quality, glycemic control, and sleep duration. The Pittsburgh Sleep Quality Index score measured sleep quality; the score is ranged from 0 to 3. Three indicated the greatest dysfunction in sleep quality. The total score ranges from 0 to 21; the higher the score, the worse the sleep quality. Glycemic control was measured by taking HbA1C levels at baseline and at a 3 to 6-month time frame. Lastly, sleep duration was measured at baseline and at the three month time interval. Secondary outcome measures included: the change in the quality of life, adherence of the parent, and the teen.

There might be a looming question as to why this study is so significant in terms of gaining knowledge to better care for patients. The main target is sleep. Sleep is frequently overlooked when it comes to diabetes management; most of the time, health care providers work tirelessly to promote healthy eating and exercise to achieve their goal. On the other hand,  most health care providers do not address the importance of sleep. What many people don’t know is that the lack of sleep can potentiate a cascade of problems such as an increase in glucose levels, carb cravings, weight gain, insulin resistance, and can contribute to lack of energy or motivation in behavior.

In the primary outcome measure of sleep quality, data had shown that there was a mean difference in the interventional group as compared to the control group that received usual care. The mean number of patients in the interventional group had overall better sleep quality as compared to the usual care. This signifies that simply having proper counseling on limiting caffeine intake and positive bedtime routine can truly impact a persons’ life. Teens do not understand the implications that sleep has on the body – which is why this is a very special population of individuals who require proper supportive care for better diabetes management. The measure for HbA1C levels showed a slight mean difference as compared to the control group. Lack of sleep overall increases HbA1C levels by approximately 1-2 percent. The patients in the interventional group had slight changes in their HbA1C levels but not anything drastic. As for the final primary outcome measure, sleep duration had a significant mean difference as well. The patients in the interventional group had experienced long hours of sleep, with little to no caffeine intake – teens were able to sleep faster and stay asleep longer, along with not using their electronic devices 1-2 hours before bedtime, that gave their minds rest in comprehending that it was time for bed.

Practice Pearls:

  • Teens with type 1 diabetes who are not adherent to their sleep schedules can experience a myriad of behavioral and psychosocial problems.
  • Health care providers need to provide proper sleep therapy counseling for teens with diabetes.
  • With proper counseling on sleep, teens begin to have a better quality of sleep, longer duration of sleep, and improved average HbA1C levels.

 

Perez, Katia M, et al. “Sleep in Type 1 Diabetes: Implications for Glycemic Control and Diabetes Management.” Current Diabetes Reports, U.S. National Library of Medicine, 5 Feb. 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5842802/.

“Sleep Promotion to Improve Diabetes Management in Adolescents With T1D – Study Results.” Study Results – ClinicalTrials.gov, https://clinicaltrials.gov/ct2/show/results/NCT02786953?recrs=e&rslt=With&cond=diabetes&draw=3&rank=83&view=results.

 “Type 1 Diabetes and Sleep – An Exciting New Technology Study with Tidepool and Evidation.” DiaTribe, 1 Sept. 2018, https://diatribe.org/type-1-diabetes-sleep-study-tidepool-evidation.

Hira Gohar, Florida A&M University, College of Pharmacy, PharmD Candidate

 

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