Sleep study finds targeted benefits for people with Type 1 diabetes

Individuals with Type 1 diabetes who had the highest baseline blood sugar levels showed a significant improvement in glucose targets after a sleep optimization program led by UIC Nursing researchers.

The results of the study were published in Diabetes Care, a journal of the American Diabetes Association. UIC Nursing Professor Pamela Martyn-Nemeth was the lead author.

The paper was the culmination of a five-year, NIH-funded trial — also led by Martyn-Nemeth — to determine if a sleep optimization intervention would help improve glucose targets, sleep variability and sleep duration in people with Type 1 diabetes who have either short or irregular sleep patterns.

Martyn-Nemeth and her team held focus groups before receiving the grant to identify challenges faced by people with Type 1 diabetes as they navigated automated insulin pumps and continuous glucose monitors.

“Sleep came up repeatedly as a challenge,” she said. “They talked about the difficulty in getting a good night’s sleep.”

People with Type 1 diabetes can face disturbances during the night, including blood sugar fluctuations, device alarms and anxiety about glucose levels, Martyn-Nemeth said.

The relationship is cyclical. People with diabetes often experience sleep disturbances, and data shows that sleep disturbances are associated with higher average blood glucose levels, Martyn-Nemeth said.

“The American Diabetes Association and American Heart Association have both identified that sleep is important for cardiovascular health and for diabetes health,” said Martyn-Nemeth.

The national study included 144 participants randomized to the Sleep-Opt intervention or the control group, both delivered remotely over 12 weeks.

Participants in the Sleep-Opt intervention received written and video content about sleep topics and weekly or biweekly phone calls from trained sleep coaches focused on individualized goals. They also received a Fitbit (wearable sleep tracker) connected to a smartphone app that provided interactive feedback on their sleep behaviors.

Participants in the control group received health education emails and follow-up phone calls from coaches to ensure they received the information, but no counseling or goal setting. There was also a 12-week post-treatment measurement.

Both groups showed improvement in self-reported sleep quality, but there was no significant difference in sleep or glucose parameters between groups over the 24-week period.

Despite this, researchers observed benefits for a subgroup within the Sleep-Opt intervention. Individuals with the highest average blood glucose levels, as measured by A1C (average blood sugar levels over the past two to three months), did see improved glucose levels compared to the control group.

“There was a significant improvement in glucose levels in those who had A1C [levels] that were higher to start with, because they had more room to improve,” Martyn-Nemeth said.

And those improvements were “clinically meaningful,” according to the paper, “comparable to the effects of some modern diabetes treatments, such as automated insulin delivery systems.”

In the paper, the authors noted that many study participants had “at goal” A1C levels, which may not be representative of the overall Type 1 diabetes population. Future studies could focus on individuals with less optimal average glucose levels, according to the paper.

A team of 18 people worked on the study and were co-authors on the paper. From UIC Nursing, they included: Alana Steffen, Laurie Quinn, Larisa Burke, Minsun Park and Adam H. Saleh, BSN ’22.

— Deborah Ziff Soriano, UIC Nursing