Association Between Sleep Duration and Glycemic Control Among Patients with Type 2 Diabetes Mellitus in India
Anil C Mathew, Elvin Benny, Jenit A Osborn, Senthil Kumar Rajasekaran, Suresh R Prabu, Ma Yunsheng
Glycemic level, Type 2 diabetes mellitus,Sleep duration
Citation Information :
Mathew AC, Benny E, Osborn JA, Rajasekaran SK, Prabu SR, Yunsheng M. Association Between Sleep Duration and Glycemic Control Among Patients with Type 2 Diabetes Mellitus in India. Indian Sleep Med 2014; 9 (1):22-28.
Context: An increasing prevalence of type 2 diabetes mellitus is a growing public health concern in India. The problem of chronic partial sleep loss due to changes in lifestyle is also rapidly increasing.
Aim: The aim of the present study was to examine the association between sleep duration and glycemic level (HbA1c) in type 2 diabetic patients.
Settings and design: This was a tertiary care hospital based cross-sectional study in India.
Materials and methods: A total of 202 patients with type 2 diabetes mellitus aged 20 years and above attending an endocrinology outpatient clinic during the month of July 2013 were studied. Information on glycosylated haemoglobin (HbA1c) value, sleep duration, age, gender, duration of diabetes, total energy intake, current smoking, current alcohol consumption, insulin use, depressive symptoms and Body Mass Index (BMI) were obtained.
Results: The adjusted mean (95% Confidence Interval (CI)) HbA1c values for subjects who slept less than 4.5 hours (h) was 9.90% (8.76, 11.19), for subjects who slept 4.5 – 6.4 h was 8.42% (8.04, 8.81), for subjects who slept 6.5 – 8.4 h was 8.18% (7.77, 8.63) and for subjects who slept more than 8.5 h was 8.28% (7.04, 9.74). Log mean HbA1c between those who slept less than 4.5 h was significantly higher compared to the subjects who slept 6.5-8.4 h (P = 0.011) and the subjects who slept 4.5-6.4 h (P = 0.013). Significant interactions were observed between sleep duration and age (<50 years and e”50 years) (P for interaction = 0.026). On the other hand, there was no significant interaction between sleep duration and gender, the presence or absence of obesity and depressive symptoms. However a significant interaction was observed between sleep duration and use of insulin therapy (P for interaction = 0.001) in predicting HbA1c.
Conclusion: This is the first epidemiological study in India to investigate the U-shaped associations of sleep duration with glycemic level in patients with type 2 diabetes mellitus. Our observations suggested that the patients with short sleep duration particularly among the elderly without insulin use should be considered high risk patients for poor glycemic control. Future studies can look into the optimal sleep duration required which may be considered as an important modifiable factor for the clinical management of patients with type 2 diabetes mellitus.
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