Endocrine Abstracts

Background: Altered sleep quality and duration have been reported in 26-67% of patients with type 1 diabetes (T1D). However, differences in study designs, populations, and methods of sleep quality assessment have led to heterogeneous results in terms of association with clinical data and blood glucose parameters.

Aims: To investigate the sleep quality of a large cohort of adult patients with autoimmune diabetes under insulin treatment, and to analyze the relationship with clinical and biochemical data.

Methods: We administered the Pittsburgh Sleep Quality Index (PSQI) questionnaire to 553 adult subjects (>18 years) with T1D or latent autoimmune diabetes of the adult (LADA). We excluded 44 patients without clinical data. Patients were also administered additional questionnaires: Diabetes Distress Scale (DDS), Diabetes-Related Quality Of Life (DRQOL), Diabetes Treatment Satisfaction Questionnaire (DTSQ), and Hypoglycemia Attitudes and Behavior Scale (HABS). We retrieved biochemical and clinical data at the time of the PSQI administration (+/- 4 months). Glucose metrics up to 3 months before PSQI administration were analyzed in 183/329 patients under continuous glucose monitoring (CGM).

Results: PSQI questionnaires had complete data in 465 patients. Altered sleep quality (PSQI score >5) was detected in 150/465 subjects (32.3%). Short sleep duration (<7 hours) was detected in 181/465 patients (38.9%). PSQI score was higher in females vs males (5.3±4.3 vs 4.7±2.9;P=0.031), with higher values of sleep latency (P=0.010), sleep disturbances (P=0.001), and daytime dysfunction (P<0.001). No difference in PSQI score were detected between patients under multiple daily injections (n=390) and insulin pump (n=75;P=0.412), and among subjects under self-monitoring of blood glucose (n=159), intermittently-scanned CGM (n=221) and real-time CGM (n=85;P=0.403), even when analyzed separately by sex. When compared to those with normal values, patients with altered sleep quality had higher glycated hemoglobin (56.4±12.1 vs 60.4±11.5;P=0.001), higher distress (DDS scores 1.9±0.9 vs 2.4±1.1; P<0.001), lower treatment satisfaction (DTSQ scores 29.3±5.4 vs 27.1±5.7; P<0.001) and lower quality of life (DRQOL scores 1.7±0.3 vs 2.0±0.4; P<0.001), whereas duration of diabetes was not different (P=0.751). No correlation was found between glucose metrics derived from CGM and parameters of sleep quality.

Conclsion: Altered sleep quality was detected in one third of the patients with autoimmune diabetes and was associated with higher glycated hemoglobin levels, rather than altered parameters of glycemic variability, irrespective of the specific treatment for diabetes. Higher distress and lower quality of life were detected in patients with altered sleep quality.