A Sleep Intervention to Improve Glycemic Control and Reduce Diabetes Distress in Working Adults with Type 1 Diabetes
- Principal Investigator
- Martyn-Nemeth, Pamela
- Funding Source
- University of Chicago
Diabetes distress is common (42% prevalence) in individuals with type 1 diabetes (T1D) and is associated with poor glycemic control. Sleep is increasingly being recognized as an important contributor to diabetes distress and glycemic control in T1D. Up to 40% of adults with T1D had a sleep duration < 6-6.5 hours per night either by self-report or objectively assessed actigraphy. Short sleep has emerged as a predictor of poor glycemic control in T1D. Increased insulin resistance likely plays a central role in this relationship as one night of experimental sleep restriction has been shown to reduce insulin sensitivity in T1D adults. Despite findings that sleep disturbances are very common in T1D, our present understanding of the effects of sleep optimization on diabetes distress and glycemic control is very limited. The purpose of this pilot and feasibility trial is to evaluate the effects of a T1D-specific sleep intervention on the outcomes of diabetes distress and glycemic control in individuals with T1D and habitual short sleep. We specifically aim to: 1) Determine the feasibility and acceptability of an eight-week T1D-specific sleep intervention. 2) Determine if a T1D-specific sleep intervention will result in improved glycemic control. 3) Determine if a T1D-specific sleep intervention will result in lower diabetes distress. To achieve these aims, we propose a randomized controlled trial in 20 adults aged 18 to 65 years with T1D. Participants will be screened for habitual sleep duration < 6.5 hours per night. Eligible subjects will be randomized to the sleep intervention group or attention control group. A one-week run-in period is planned with baseline measures of diabetes distress, HbA1c, fructosamine, glycemic variability (using continuous glucose monitoring) and objectively measured sleep duration. The sleep intervention will entail a novel technology-assisted behavioral sleep extension intervention that we recently developed to leverage rapidly increasing public interest in sleep tracking by consumers (+500% in 3 years). Our technology employs four elements: a wearable sleep tracker, didactic content, an interactive smartphone application, and brief telephone counseling. For this proposal, we will further optimize our intervention to be T1D-specific by incorporating the aspect of sleep regularity and addressing T1D-related sleep issues such as nocturnal hypoglycemia. The attention control group will participate in a healthy living information program. At completion (week 8) and post-program (weeks 12 and 24), baseline measures will be repeated to determine differences between the two groups and sustainability of the intervention. Findings from this proposed pilot study will serve as the foundation for a larger clinical trial to improve sleep, reduce diabetes distress and improve glycemic control.