The Temporal Association Between Sleep and Glucose Among Young Adults with Type 1 Diabetes

Achieving the recommended A1C level (< 7%) is the primary focus of type 1 diabetes (T1D) management and glycemic control. However, approximately 80% of young adults with T1D fail to meet glycemic targets. Sleep is a potential target to improve glycemic control. This study aimed to describe the sleep characteristics (sleep quality, sleep efficiency, sleep duration, sleep regularity, sleep latency, sleep fragmentation, and wake after sleep onset) and glycemic parameters (mean glucose level, glycemic variability, and glycemic control) of the young adult sample and identify between-person associations. In addition, it aimed to identify within-person associations as well as factors modifying glycemic parameter outcomes. This secondary analysis included a sample of 53 young adults with T1D aged between 18 and 40 years, using baseline data from an ongoing randomized controlled trial study. The mean age of this sample was 30.2, primarily female 64.15% and 81.13% White. The mean diabetes duration was 16.3 years with 69.81% using insulin pumps and 88.68% using CGM. Of the 53 participants, 45.28% reported “fairly bad” sleep quality. The median of sleep efficiency was 86.68%, 01:17 hour of mid-sleep time, 10:11 minutes of sleep latency, and 16.82 of sleep fragmentation index. Approximately one-third (30.19%) of the sample had an average wake after sleep onset of ≥40 minutes. Sleep duration and sleep regularity significantly predicted time below range of glucose levels. No significant temporal associations were observed between sleep characteristics and glycemic parameters in the study sample. Self-management behavior was a significant moderator for the association between sleep regularity and time below range, where better self-management behavior decreased the association between the mid-sleep time and time below range. In conclusion, short sleep duration and sleep irregularity were the key sleep characteristics found to be significantly associated with poor glycemic variability among young adults with T1D. The findings of this study emphasize the importance of routine sleep health evaluation for this population. Further research is required to establish causal relationships between sleep characteristics and glycemic parameters while considering potential factors that might contribute to the lack of significant associations observed in the present study among young adults with T1D.