Posted Nov 21 , 2017 02:06 AM

Sleep duration and progression to diabetes in people with prediabetes defined by HbA1c concentration

Kim CW, et al. Diabetic Medicine 2017 online ahead of print

What were the findings (excerpted from the Abstract)?

To evaluate the association between sleep duration and the risk of progression to diabetes among people with prediabetes, defined by HbA1c values. The authors conducted a cohort study in 17,983 adults who underwent health check-up examinations, including assessments of sleep duration and quality. Diabetes was defined as either HbA1c ≥48 mmol/mol (6.5%), or the use of antidiabetic medication. Sleep time and quality were assessed at baseline and subsequent visits using a standard questionnaire. Time-dependent proportional hazards models were used to evaluate the association between sleep duration and the risk of progression to diabetes. During 31,582 person-years of follow-up, 664 incident cases of diabetes were identified; the incidence rate was 21.0 per 1,000 person-years. The multivariate adjusted hazard ratios for progression to diabetes in people with sleep durations of ≤5, 6 and ≥8 hours compared with 7 hours were 1.68, 1.44, and respectively all results being statistically significant. This association was partially mediated by biomarkers of adiposity, fatty liver and insulin resistance. In this large study in young and middle-aged adults with prediabetes, the authors found an association between short sleep duration and the risk of progression to diabetes. These findings in a Korean population suggest that sufficient sleep duration is important for delaying or preventing the progression of prediabetes to diabetes.

Why is this important?

Sleep duration has emerged as an important lifestyle factor that influences glucose metabolism. Prospective studies suggest that sleep duration has a U-shaped association with the risk of developing diabetes. U.S. National surveys have suggested that 29% of individuals report sleeping less than 7 hours a night. Compared with participants who slept for 7 hours, those with shorter sleep durations were more likely to be male, and have significant depressive symptoms, poorer subjective sleep quality, and higher levels of insulin resistance. Along with weight gain, activation of the sympathetic nervous system and cortisol dysregulation attributed to sleep loss can produce the features of glucocorticoid excess associated with decreased glucose tolerance, insulin resistance and visceral adiposity. In addition, insufficient sleep is associated with increases in inflammatory mediators, such as interleukin- 6 and hsCRP, potentially as a result of activation of the stress system. In short, there are many negative features of lack of sleep, and practitioners should assess sleep duration and quality along with glucose levels in people with prediabetes, and where possible prescribe techniques that aid in promoting quality sleep and sleep duration
Do you question individuals in your practice about their sleep duration or quality? Will you now?

Read the abstract: