Poor Sleep Duration in Type 2 Diabetes Tied to Greater Microvascular Disease Risk

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Receiving below 7 hours or over 9 hours of sleep with type 2 diabetes is linked to a greater prevalence of microvascular disease, a recent study found.¹

It was already discovered receiving fewer than 6 hours or more than 10 hours of sleep, as well as having poor quality of sleep, is linked to a greater diabetes risk.² A meta-analysis on this topic was presented at last year’s Endocrine Society Annual Meeting in Chicago. However, not only does sleep duration impact the diabetes risk—it impacts diabetes-related complications.¹

Evidence suggests sleep duration variations may influence the risk of developing diabetes-related complications, such as retinopathy and nephropathy. These diseases are major contributors to morbidities associated with Type 2 Diabetes Mellitus.

Investigators, led by Mette Johansen and Thomas Olesen, from Steno Diabetes Center Odense at Odense University Hospital, in Denmark, aimed to explore the relationship between sleep duration and the microvascular disease presence in individuals newly diagnosed with Type 2 Diabetes Mellitus. Thus, they conducted a cross-sectional analysis, leveraging data from The Specialist Supervised Individualized Multifactorial Treatment of New Clinically Diagnosed Type 2 Diabetes in General Practice, a sub-study from the Danish Centre for Strategic Research in Type Diabetes cohort.

Sleep duration was measured using Axivity AX3 accelerometers, worn for 10 days, and was classified as short (< 7 hours), optimal (7 – 9 hours), and long (≥ 9 hours). Moreover, microvascular disease was identified by either a urine albumin/creatinine ratio ≥ 30 mg/d or the presence of diabetic retinopathy evaluated by either mydriatic retinal imaging or ophthalmoscopy. Investigators analyzed sleep duration with logistic regression and adjusted for age, sex, body mass index (BMI), systolic blood pressure, smoking habits, HbA1c, duration of diabetes, and antihypertensive treatment.

The study included 396 participants with a mean age of 62 years (IQR, 53 – 68). The mean diabetes duration was 3.5 3.5 ± 2.7 years, and 175 were females (44%). Most of the sample was overweight, with a median BMI of 31 (IQR, 28 – 35) and more than half (68%) were on antihypertensive medication. All participants had valid sleep duration measurements, urine albumin/creatinine ratio measurements, and an eye examination.

In total, 12% (n = 49) of participants had a short sleep duration, 60% (n = 238) had an optimal sleep duration, and 28% had a long sleep duration. Additionally, the prevalence of microvascular damage was 38%, 18%, and 31% in the short, optimal, and long sleep duration groups, respectively.

Investigators saw a short sleep duration had approximately 2.6 increased odds of microvascular disease (odds ratio [OR], 2.63; 95% confidence interval [CI], 1.32 – 5.26). Likewise, long sleep duration was independently associated with 2.3 increased odds of microvascular disease (OR, 2.29; 95% CI, 1.32 – 3.97).

The team noted age plays a role in the link between short sleep duration and microvascular disease. The likelihood of the association was 1.23 for participants < 62 years (OR, 1.23; 95% CI, 0.45 – 3.55) and 5.67 for people > 62 years old (95% CI, 2.10 – 15.27; P =

“In recently diagnosed [Type 2 Diabetes Mellitus] patients, both short and long sleep durations are associated with a higher prevalence of microvascular disease compared to optimal sleep duration at night,” investigators concluded. “Age amplifies the association between short sleep duration and microvascular disease, suggesting increased vulnerability among older individuals.

References

1. ^{Study Finds Short and Long Sleep Duration Associated with Blood Vessel Damage In Those Recently Diagnosed With Type 2 Diabetes. EurekAlert! July 11, 2024. https://www.eurekalert.org/news-releases/1050941. Accessed July 18, 2024.}
2. ^{Iapoce, C. Duration, Poor Quality of Sleep Associated with Increased Risk for Diabetes. HCPLive. June 16, 2023. https://www.hcplive.com/view/duration-poor-quality-sleep-associated-increased-risk-diabetes. Accessed July 18, 2024.}