Interplay among sleep quality, dinner timing, and blood glucose control in users of advanced technologies: A study in a cohort of adults with type 1 diabetes

Aims: To explore the interplay among sleep quality, dinner timing, and glycemic control in adults with type 1 diabetes (T1D) using advanced diabetes technologies. Methods: T1D adults on automated (AID, n = 122) or non-automated (CSII, n = 67) insulin delivery systems completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Two-week CGM-metrics, HbA1c, and post-dinner glucose control were compared by independent T-test in Good vs. Bad-sleepers (PSQI-score above 5) or in Early vs. Late-eaters (above median of the cohort's dinner time). Results: Time-below-range (TBR)(70-54) (2.1 +/- 2.0 vs. 1.3 +/- 1.2 %), TBR54 (0.7 +/- 1.0 vs. 0.2 +/- 0.4 %), and coefficient of variation (34.4 +/- 5.3 vs. 31.8 +/- 5.2 %) were significantly higher in Bad-sleepers than Good-sleepers (p < 0.05 for all). Late-eaters, particularly among AID users, showed higher HbA1c and lower TBR70-54, and, after dinner, higher TAR(180-250) and lower Time-in-range(70-180) than Early-eaters (p < 0.05 for all). At multiple regression analysis, dinner time was a main predictor of HbA1c, and TBR54 a main predictor of sleep quality. Conclusions: The rate of hypoglycemia and dinner timing are key factors affecting both sleep quality and glycemic control in adults with T1D. Addressing lifestyle habits, including dinner timing and fear of hypoglycemia, may still be needed in users of AID.