Short or long sleep duration is associated with microvascular disease in patients with newly diagnosed diabetes

According to a new study being presented at this year's European Association for the Study of Diabetes (EASD) Annual Meeting (Madrid, September 9-13), people with newly diagnosed diabetes who sleep less or more may be more likely to suffer from microvascular disease (damage to small blood vessels), which may ultimately lead to more serious complications. The study is by Mette Johansen and Thomas Olsen of the Steno Diabetes Center, Odense University Hospital, Odense, Denmark, and colleagues.

Microvascular complications, such as retinopathy and nephropathy, are the main cause of complications associated with type 2 diabetes mellitus (T2D). Increasing evidence suggests that changes in sleep duration may affect the risk of developing diabetes-related complications. This study aimed to investigate the relationship between sleep duration and the presence of microvascular disease in people with newly diagnosed T2D.

For their analysis, the authors used data from the Specialist-Supervised Individualized Multifactorial Treatment of Newly Clinically Diagnosed Type 2 Diabetes in General Practice (IDA) study, a substudy of the Danish Strategic Research Centre for Type 2 Diabetes (DD2) cohort.

Nighttime sleep duration was measured using an Axivity AX3 accelerometer worn by participants for 10 days. Nighttime sleep duration was classified into three categories: short (<7 hours), optimal (7 to <9 hours), and long (≥9 hours). Microvascular disease (damage to small blood vessels) was defined as a urinary albumin/creatinine ratio (UACR) ≥30 mg/g or the presence of diabetic retinopathy (DR) assessed by either mydriatic retinal imaging or fundus examination.

We then applied computer modelling to estimate odds ratios (ORs) between sleep duration groups using optimal sleep duration as the reference group, adjusted for age, sex, BMI, systolic blood pressure, smoking habit, glycated hemoglobin (HbA1c – a marker of glycemic control), diabetes duration and antihypertensive treatment.

A total of 396 participants had valid sleep duration, UACR measurements, and eye examinations. Median age was 62 years, mean duration of diabetes was 3.5 years, and 175 (44%) were women. The cohort was largely made up of overweight individuals, with a median BMI of 31 (obese range), and 68% (n=285) were taking antihypertensive medication.

The distribution of sleep duration was 12% (n=49) for short sleep duration, 60% (n=238) for optimal sleep duration, and 28% (n=109) for long sleep duration. The prevalence of microvascular damage was 38%, 18%, and 31% in the short, optimal, and long sleep duration groups, respectively. Short sleep duration was significantly associated with a 2.6-fold increased risk of microvascular disease compared to optimal sleep duration. Similarly, long sleep duration was independently associated with a 2.3-fold increased risk of microvascular disease compared to optimal sleep duration.

Furthermore, the association between short sleep duration and microvascular disease was accentuated by age. Interestingly, for participants under 62 years of age, short sleep duration was associated with only a 23% increased risk of microvascular damage compared to optimal sleep duration. Meanwhile, for participants aged 62 years or older, short sleep duration was associated with a 5.7-fold increased risk of small vessel damage compared to optimal sleep duration. The effect of age on the relationship between long sleep duration and microvascular disease was not statistically significant.

The authors conclude: “In patients with recently diagnosed type 2 diabetes, both short and long sleep durations compared with optimal nighttime sleep duration are associated with a higher prevalence of microvascular disease. The association between short sleep duration and microvascular disease strengthens with age, suggesting increased vulnerability in older adults.“

They added:Lifestyle changes Type 2 diabetes patients Sleep interventions may include: however, further studies are needed to establish the role of sleep duration and quality in these patients.“