The association between glycaemic variability and sleep quality and quantity in adults with type 1 and type 2 diabetes: A systematic review

Cecilia T Pham; Aleena Ali; Leonid Churilov; Sara Baqar; Christel Hendrieckx; David N O'Neal; Mark E Howard; Elif I Ekinci

doi:10.1111/dme.15485

The association between glycaemic variability and sleep quality and quantity in adults with type 1 and type 2 diabetes: A systematic review

Diabet Med. 2024 Dec 11:e15485. doi: 10.1111/dme.15485. Online ahead of print.

Authors

Cecilia T Pham^{1

2

3}, Aleena Ali^{1

3

4}, Leonid Churilov^{1

3

5}, Sara Baqar^{6

7}, Christel Hendrieckx^{3

8

9}, David N O'Neal^{1

3

10}, Mark E Howard^{1

11

12

13}, Elif I Ekinci^{1

2

3}

Affiliations

¹ Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.
² Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia.
³ The Australian Centre for Accelerating Diabetes Innovations (ACADI), University of Melbourne, Parkville, Victoria, Australia.
⁴ Department of Diabetes and Endocrinology, University College London Hospital, London, UK.
⁵ Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia.
⁶ Department of General Medicine, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia.
⁷ Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.
⁸ The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Carlton, Victoria, Australia.
⁹ School of Psychology, Deakin University, Burwood, Victoria, Australia.
¹⁰ Department of Endocrinology and Diabetes, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
¹¹ Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia.
¹² Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia.
¹³ School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia.

PMID: 39663626
DOI: 10.1111/dme.15485

Abstract

Aims: Individuals with diabetes frequently encounter sleep disturbances, which can detrimentally impact glycaemic management. We reviewed the relationship between sleep outcomes and glycaemic variability in adults with diabetes.

Methods: We systematically searched Medline, EMBASE and Cochrane Library (2002-March 2023) for studies evaluating sleep and glycaemic variability in adults with type 1 and type 2 diabetes. Among the 3049 records, 27 met the inclusion criteria (type 1 diabetes studies = 22). Due to methodological heterogeneity, a qualitative analysis was conducted.

Results: Most studies measuring sleep quality (5 out 7; 71%) reported a significant association with glycaemic variability in type 1 and type 2 diabetes. Sleep duration was not significantly associated with glycaemic variability in type 1 diabetes, whereas other sleep metrics yielded inconclusive results. Hybrid closed-loop pump interventions (n = 12) demonstrated varying sleep outcomes with improved glycaemic variability. Similarly, sleep interventions (n = 3) consistently enhanced sleep but not glycaemic variability. Limitations included moderate to high risk of study bias, confounders, methodological heterogeneity and limited type 2 diabetes data.

Conclusions: A potential association between sleep quality and glycaemic variability exists. However, associations with other sleep metrics remain elusive, with no discernible association between sleep duration and glycaemic variability in type 1 diabetes. Despite advancements in continuous glucose monitoring and ambulatory sleep monitoring, standardised sleep assessment methodologies are lacking in real-world studies. Establishing standard protocols for sleep assessment and defining optimal sleep targets are crucial for meaningful comparisons between studies. Understanding the complex interplay between sleep and glycaemic variability holds promise in improving diabetes management and sleep health.

Keywords: blood glucose; glycaemic variability; sleep; sleep assessment; type 1 diabetes; type 2 diabetes.

Publication types

Review

Grants and funding

Australian Centre for Accelerating Diabetes Innovations