The association of self-reported sleep and circadian measures with glycemic control and diabetes complications among young adults with type 2 diabetes: Results from the TODAY2 study

Authors: KOREN, DORIT - Massachusetts General Hospital; KNUTSON, KRISTEN - Northwestern University; BURKE, BRIAN - George Washington University; DREWS, KIMBERLY - George Washington University; BACHA, FIDA - Children'S Nutrition Research Center (CNRC); KATZ, LORRAINE - Children'S Hospital - Philadelphia, Pennsylvania; MARCUS, MARSHA - University Of Pittsburgh School Of Medicine; MCKAY, SIRIPOOM - Baylor College Of Medicine; NADEAU, KRISTEN - University Of Colorado; MOKHLESI, BABAK - Rush University Medical Center

Submitted to: American Journal of Physiology - Heart and Circulatory Physiology
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/4/2024
Publication Date: 5/13/2024
Citation: Koren, D., Knutson, K.L., Burke, B.K., Drews, K.L., Bacha, F., Katz, L., Marcus, M.D., McKay, S., Nadeau, K., Mokhlesi, B., and on behalf of the TODAY Study Group. 2024. The association of self-reported sleep and circadian measures with glycemic control and diabetes complications among young adults with type 2 diabetes: Results from the TODAY2 study. American Journal of Physiology - Heart and Circulatory Physiology. 326(6);H1386–H1395. https://doi.org/10.1152/ajpheart.00550.2023.
DOI: https://doi.org/10.1152/ajpheart.00550.2023

Interpretive Summary: The prevalence of type 2 diabetes in youth is increasing at an alarming rate. Identifying potentially modifiable factors (such as sleep) in modulating glycemic control is critically important to reduce cardiovascular disease risk and complications. The researchers were interested in studying the relationship of sleep behaviors (including duration and timing) to the glucose control in youth with type 2 diabetes. They hypothesized that sleep duration less than 6 hours, and self-perceived poor sleep quality, and late bedtime are associated with worse glycemic control. They evaluated sleep duration, quality and timing in a large cohort of youth with type 2 diabetes from the multicenter TODAY clinical trial using validated questionnaires. Sleep duration was not related to glucose control. Rather, the study found that self-reported late bedtime on work/school days was independently associated with loss of glucose control in this longitudinal cohort of young adults with youth-onset type 2 diabetes. Future intervention studies are needed to test sleep interventions in youth with type 2 diabetes to test whether this intervention can improve diabetes outcomes and prevent complications in these youth.

Technical Abstract: We aim to examine the association of sleep duration, sleep quality, late chronotype and circadian misalignment with glycemic control and risk of complications in young adults with youth-onset type 2 diabetes followed in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study. Self-reported sleep duration, quality, timing, and circadian misalignment were assessed via a modified Pittsburgh Sleep Quality Index (PSQI) questionnaire, and chronotype was assessed via the Morningness-Eveningness Questionnaire (MEQ). We examined diabetes complications including loss of glycemic control (defined as hemoglobin A1c >/-8%), hypertension, dyslipidemia, albuminuria, and diabetic peripheral neuropathy. Multivariable logistic regression models were constructed to assess associations between sleep and circadian measures with outcomes of interest, such as loss of glycemic control and diabetes complications. A total of 421 participants (34.2% male), mean age 23.6+/-2.5 years, mean BMI of 36.10+/-8.26 kg/m2 and mean diabetes duration of 10.0+/-2.5 years were evaluated. Self-reported short sleep duration, daytime sleepiness, and sleep quality were not associated with loss of glycemic control or diabetes complications. Late self-reported bedtime (after midnight) on work/school nights, rather than self-expressed chronotype or circadian misalignment, was independently associated with loss of glycemic control. An association was seen between late bedtimes and albuminuria but was attenuated after adjusting for depression. In conclusion, late bedtime on work/school days, rather than short sleep duration, daytime sleepiness, or poor sleep quality, was independently associated with loss of glycemic control in this longitudinal cohort of young adults with youth-onset type 2 diabetes.