German study investigates sleep quality and quantity and glycaemia in adolescents with type 1 diabetes.
by Virginia Hagger
Sleep duration and quality have progressively declined among adolescents over the past few decades. Adolescents are more likely to commence their sleep later, have a later circadian phase, and sleep for a shorter duration than adults. As they often wake early for school, they tend to accumulate high sleep debts during the week, which they try to compensate for during the weekend (known as ‘social jetlag’, a mismatch between a person’s social schedule and ‘body clock’ sleeping preferences). Inadequate sleep is associated with increased risk for type 2 diabetes, and impaired insulin sensitivity in adults with type 1 diabetes. This cross-sectional study investigated the relationship between sleep parameters (sleep quality, debt, duration, chronotype, and social jetlag) and insulin sensitivity, self-care and HbA1c, among people with type 1 diabetes aged 12 to 21 years.
On average participants slept 7.7 hours per night, and reported modest sleep deprivation and social jetlag (the difference between the mid-points of sleep on work vs work-free days ). The study found that poor low sleep quality but not sleep duration was associated with higher HbA1c, and this relationship was strongest for boys and adolescents from a migrant background. The difference in HbA1c between the highest and lowest quartile for sleep quality was 0.35% (3.8 mmol/mol). Sleep duration, sleep debt, chronotype, social jetlag and type of diabetes therapy were not associated with HbA1c. Social jetlag was associated with higher insulin requirements, which most likely compensated for increased blood glucose, and the most likely reason social jetlag was not associated with elevated HbA1c. Sleep scores were not associated with self-care.
Youth in this study reported a higher average Sleep Quality Score (range 4-26; higher scores indicate higher sleep quality) than participants of an Australian pilot study (21 vs 18) referred to in the paper. Sleep is not often a focus of studies among adolescents with type 1 diabetes, but low sleep quality could have adverse metabolic consequences for young people. The association between sleep and metal health are well recognised. This study raises awareness of low sleep quality and diabetes management in youth, and it would be useful to consider sleep when examining physical as well as mental health and well-being among people with diabetes.
von Schnurbein J , Boettcher C , Brandt S , Karges B , Dunstheimer D , Galler A , Denzer C , Denzer F , Vollbach H , Wabitsch M , Roenneberg T , Vetter C . Sleep and glycemic control in adolescents with type 1 diabetes.  Pediatric Diabetes. 2017;0:1–7. https://doi.org/10.1111/pedi.12538