scholarly journals Improvement in Patient-Reported Sleep in Type 2 Diabetes and Prediabetes Participants Receiving a Continuous Care Intervention with Nutritional Ketosis

2018 ◽  
Author(s):  
Morgan J. Siegmann ◽  
Shaminie J Athinarayanan ◽  
Sarah J Hallberg ◽  
Amy L. McKenzie ◽  
Nasir H. Bhanpuri ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Sleep Quality ◽  
Sleep Disturbance ◽  
Dietary Intervention ◽  
Poor Sleep ◽  
Continuous Care ◽  
Care Intervention ◽  
Patient Reported ◽  
One Year

AbstractObjectiveSleep disruption is frequently associated with type 2 diabetes (T2D) and hyperglycemia. We recently reported the effectiveness of a continuous care intervention (CCI) emphasizing nutritional ketosis for improving HbA1c, body weight and cardiovascular risk factors in T2D patients. The present study assessed the effect of this CCI approach on sleep quality using a subjective patient-reported sleep questionnaire.MethodsA non-randomized, controlled longitudinal study; 262 T2D and 116 prediabetes patientsenrolled in the CCI and 87 separately recruited T2D patients continued usual care (UC) treatment. Patients completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire. A PSQI score of >5 (scale 0 to 21) was used to identify poor sleepers.ResultsGlobal sleep quality improved in the CCI T2D (p<0.001) and prediabetes (p<0.001) patients after one year of intervention. Subjective sleep quality (component 1), sleep disturbance (component 5) and daytime dysfunction (component 7), also showed improvements in the CCI T2D (p<0.01 for sleep quality and sleep disturbance; and p<0.001 for daytime dysfunction) and prediabetes patients (p<0.001 for all three components); compared to the UC T2D group after one year. The proportion of patients with poor sleep quality was significantly reduced after one year of CCI (T2D; from 68.3% at baseline to 56.5% at one year, p=0.001 and prediabetes; from 77.9% at baseline to 48.7% at one year, p<0.001).ConclusionThis study demonstrates improved sleep quality as assessed by PSQI in patients with T2D and prediabetes undergoing CCI including nutritional ketosis but not in T2D patients receiving UC. The dietary intervention benefited both sleep quality and the severity of T2D symptoms suggesting that nutritional ketosis improves overall health via multiple mechanisms.

scholarly journals Improvement in patient-reported sleep in type 2 diabetes and prediabetes participants receiving a continuous care intervention with nutritional ketosis

2019 ◽  
Vol 55 ◽  
pp. 92-99 ◽  
Author(s):  
Morgan J. Siegmann ◽  
Shaminie J. Athinarayanan ◽  
Sarah J. Hallberg ◽  
Amy L. McKenzie ◽  
Nasir H. Bhanpuri ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Continuous Care ◽  
Care Intervention ◽  
Patient Reported

scholarly journals Post-hoc analyses of Surrogate Markers of Non-Alcoholic Fatty Liver Disease (NAFLD) and Liver Fibrosis in Patients with Type 2 Diabetes in a Digitally-Supported Continuous Care Intervention: An Open Label, Non-Randomized, Controlled Study

2018 ◽  
Author(s):  
Eduardo Vilar-Gomez ◽  
Shaminie J. Athinarayanan ◽  
Rebecca N. AdamS ◽  
Sarah J. Hallberg ◽  
Nasir H. Bhanpuri ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Advanced Fibrosis ◽  
Alcoholic Fatty Liver ◽  
Continuous Care ◽  
Care Intervention ◽  
One Year ◽  
Alcoholic Fatty Liver Disease

ABSTRACTObjectiveOne-year of comprehensive continuous care intervention (CCI) through nutritional ketosis improves HbA1c, body weight and liver enzymes among type 2 diabetes (T2D) patients. Here, we report the effect of the CCI on surrogate scores of non-alcoholic fatty liver disease (NAFLD) and liver fibrosis.MethodsThis was a non-randomized longitudinal study, including adults with T2D who were self-enrolled to the CCI (n=262) or to receive usual care (UC, n=87) during one year. A NAFLD liver fat score [N-LFS] > −0.640 defined the presence of fatty liver. A NAFLD fibrosis score [NFS] of > 0.675 identified subjects with advanced fibrosis. Changes in N-LFS and NFS at one year were the main endpoints.ResultsAt baseline, NAFLD was present in 95% of patients in the CCI and 90% of patients in the UC. At one year, weight loss of > 5% was achieved in 79% of patients in the CCI vs. 19% of patients in UC (P<0.001). N-LFS mean score was reduced in the CCI group (−1.95±0.22, P<0.001) whereas it was not changed in the UC (0.47±0.41, P=0.26) (CCI vs. UC, P<0.001). NFS was reduced in the CCI group (−0.65±0.06, P<0.001) compared with UC (0.26±0.11, P=0.02) (P<0.001 between two groups). In the CCI group, the percentage of individuals with a low probability of advanced fibrosis increased from 18% at baseline to 33% at 1 year (P<0.001).ConclusionsOne year of a digitally-supported CCI significantly improved surrogates of NAFLD and advanced fibrosis in patients with type 2 diabetes.DATA SHARINGData sets and statistical code used for the current study are available from the corresponding author on reasonable request.Article Summary Strengths and limitations of this studyThis study highlights the beneficial effect of the CCI on NAFLD in high risk patients with T2DThis study also identifies positive associations between glycemic improvements and improvements in ALT levelsThe assessment of resolution of steatosis and fibrosis is limited by the sensitivity and specificity of the non-invasive markers used in the studyThe patients were restricted in their carbohydrate intake and monitored for their nutritional ketosis state, but dietary energy, macronutrient and micronutrient intakes were not assessed.

scholarly journals Post hoc analyses of surrogate markers of non-alcoholic fatty liver disease (NAFLD) and liver fibrosis in patients with type 2 diabetes in a digitally supported continuous care intervention: an open-label, non-randomised controlled study

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e023597 ◽  
Author(s):  
Eduardo Vilar-Gomez ◽  
Shaminie J Athinarayanan ◽  
Rebecca N Adams ◽  
Sarah J Hallberg ◽  
Nasir H Bhanpuri ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Advanced Fibrosis ◽  
Alcoholic Fatty Liver ◽  
Continuous Care ◽  
Care Intervention ◽  
One Year ◽  
Alcoholic Fatty Liver Disease

ObjectiveOne year of comprehensive continuous care intervention (CCI) through nutritional ketosis improves glycosylated haemoglobin(HbA1c), body weight and liver enzymes among patients with type 2 diabetes (T2D). Here, we report the effect of the CCI on surrogate scores of non-alcoholic fatty liver disease (NAFLD) and liver fibrosis.MethodsThis was a non-randomised longitudinal study, including adults with T2D who were self-enrolled to the CCI (n=262) or to receive usual care (UC, n=87) during 1 year. An NAFLD liver fat score (N-LFS) >−0.640 defined the presence of fatty liver. An NAFLD fibrosis score (NFS) of >0.675 identified subjects with advanced fibrosis. Changes in N-LFS and NFS at 1 year were the main endpoints.ResultsAt baseline, NAFLD was present in 95% of patients in the CCI and 90% of patients in the UC. At 1 year, weight loss of ≥5% was achieved in 79% of patients in the CCI versus 19% of patients in UC (p<0.001). N-LFS mean score was reduced in the CCI group (−1.95±0.22, p<0.001), whereas it was not changed in the UC (0.47±0.41, p=0.26) (CCI vs UC, p<0.001). NFS was reduced in the CCI group (−0.65±0.06, p<0.001) compared with UC (0.26±0.11, p=0.02) (p<0.001 between two groups). In the CCI group, the percentage of individuals with a low probability of advanced fibrosis increased from 18% at baseline to 33% at 1 year (p<0.001).ConclusionsOne year of a digitally supported CCI significantly improved surrogates of NAFLD and advanced fibrosis in patients with T2D.Trial registration numberNCT02519309; Results.

scholarly journals Melatonin Concentrations and Sleep Quality in Patients with Type 2 Diabetes and Obesity

2019 ◽  
Vol 73 (2) ◽  
pp. 152-157
Author(s):  
Ieva Kalere ◽  
Ilze Konrāde ◽  
Anna Proskurina ◽  
Sabīne Upmale ◽  
Tatjana Zaķe ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Retinopathy ◽  
Sleep Quality ◽  
Insulin Analogues ◽  
Control Group ◽  
Poor Sleep ◽  
Poor Sleep Quality ◽  
Acting Insulin ◽  
Short Acting Insulin

Abstract There is a close relationship between melatonin as a circadian regulator and insulin, glucagon and somatostatin production. This study aimed to describe subgroups of type 2 diabetes mellitus (T2DM) patients that may benefit from melatonin clock-targeting properties. The study involved 38 participants: 26 T2DM patients, and 12 participants without diabetes in the control group. Subjects were asked to complete the questionnaire of Pittsburgh Sleep Quality Index (PSQI). Standard biochemical venous sample testing was performed, and a sample of saliva was collected for melatonin testing. Melatonin concentration in participants without obesity (body mass index (BMI) < 30 kg/m2) was significantly higher than in obese participants: 13.2 (6.4; 23.50) pg/ml vs 5.9 (0.78; 13.1) pg/ml, p = 0.035. Subjects with BMI 30 kg/m2 had a significantly higher PSQI score than non-obese subjects: 7 (4.5; 10) vs 5.5 (3; 7), p = 0.043. T2DM patients showed significantly lower levels of melatonin than the control group: 6.1 (0.78; 12.2) pg/ml vs 17.8 (8.2; 25.5) pg/ml, p = 0.003. T2DM patients using short-acting insulin analogues showed a significantly higher PSQI score than patients not using insulin: 9 (6; 10) vs 6 (3; 8), respectively (p = 0.025). Poor sleep quality was more prevalent in patients with diabetic retinopathy than in those without this complication (p = 0.031). Lower melatonin levels were detected in T2DM and obese patients. Furthermore, poor sleep quality was observed in T2DM patients using short-acting insulin analogues and those with diabetic retinopathy, and obese individuals.

Sleep Disturbance in Psoriatic Disease: Prevalence and Associated Factors

2017 ◽  
Vol 44 (9) ◽  
pp. 1369-1374 ◽  
Author(s):  
Ian T.Y. Wong ◽  
Vinod Chandran ◽  
Suzanne Li ◽  
Dafna D. Gladman
Keyword(s):  
Psoriatic Arthritis ◽  
Sleep Quality ◽  
Sleep Disturbance ◽  
Quality Index ◽  
Short Form ◽  
Life Quality ◽  
Poor Sleep ◽  
Poor Sleep Quality ◽  
Psoriatic Disease ◽  
Patient Reported

Objective.We aimed to determine the prevalence and quality of sleep in patients with psoriatic arthritis (PsA) and those with psoriasis without PsA (PsC) followed in the same center, to identify factors associated with sleep disturbance, and to compare findings to those of healthy controls (HC).Methods.The study included 113 PsA [ClASsification for Psoriatic ARthritis (CASPAR) criteria] and 62 PsC (PsA excluded by a rheumatologist) patients and 52 HC. Clinical variables were collected using a standard protocol. The sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Other patient-reported outcomes collected included the Health Assessment Questionnaire (HAQ), Dermatology Life Quality Index, EQ-5D, Medical Outcomes Study Short Form-36 survey, patient’s global assessment, and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-fatigue) scale. Statistical analyses included descriptive statistics, Wilcoxon rank-sum test, and linear regression.Results.The prevalence of poor sleep quality was 84%, 69%, and 50% in PsA, PsC, and HC, respectively. Total PSQI score was higher in both patients with PsA and patients with PsC compared with HC (p < 0.01) and higher in patients with PsA compared to patients with PsC (p < 0.0001). EQ-5D anxiety component, EQ-5D final, and FACIT-fatigue were independently associated with worse PSQI in patients with PsC and those with PsA (p < 0.05). Actively inflamed (tender or swollen) joints are independently associated with worse PSQI in patients with PsA (p < 0.01).Conclusion.Patients with psoriatic disease have poor sleep quality. Poor sleep is associated with fatigue, anxiety, and lower EQ-5D. In patients with PsA, poor sleep is associated with active joint inflammation.

Poor Sleep Quality Linked to Decreased Brain Gray Matter Density in Adults with Type 2 Diabetes

2021 ◽  
Author(s):  
Cristina Cabrera-Mino ◽  
Bhaswati Roy ◽  
Mary A. Woo ◽  
Matthew J. Freeby ◽  
Rajesh Kumar ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Sleep Quality ◽  
Gray Matter ◽  
Matter Density ◽  
Poor Sleep ◽  
Poor Sleep Quality ◽  
Gray Matter Density

scholarly journals MON-698 Association of Sleep Quality and Painless Diabetic Peripheral Neuropathy in Type 2 Diabetes

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Dughyun Choi ◽  
Bo Yeon Kim ◽  
Chan-Hee Jung ◽  
Chul-Hee Kim ◽  
Jioh Mok
Keyword(s):  
Type 2 Diabetes ◽  
Peripheral Neuropathy ◽  
Sleep Quality ◽  
Diabetic Peripheral Neuropathy ◽  
Poor Sleep ◽  
Poor Sleep Quality ◽  
The Poor ◽  
Painful Sensation ◽  
Good Sleep

Abstract Aims Diabetic peripheral neuropathy (DPN) is one of the most common and early manifested complication in T2D. Previous reports have shown that painful sensation of diabetic peripheral neuropathy (DPN) results in sleep problems in type 2 diabetes (T2D)1, 2. However, it is not known that subtype of DPN, the painless DPN also is associated with poor sleep quality in T2D. The purpose of the current study was to investigate the association between painless DPN and poor sleep quality in T2D. Methods A total of 146 patients of T2D who did not previously diagnose with symptomatic DPN were recruited into the study. Among the patients, painless DPN was diagnosed by using the current perception threshold (CPT) test. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Results The percentage of painless DPN was significantly higher in the poor sleep quality group than the good sleep quality group (70.0% vs. 35.5%, P&lt;0.001). In the subscale results, stimulus values in 2000 Hz, hypoesthesia and hyperesthesia were significantly higher in the poor sleep quality group, than in the good sleep quality group (45.7% vs. 25.0%, P=0.009; 34.3% vs. 18.4%, P=0.029; 40.0% vs. 19.7%, P=0.007, respectively). The association of painless DPN and poor sleep quality remained significant after adjustment for significant variants (odds ratio, 3.825; 95% confidence interval, 1.674-8.742; P&lt;0.001). Conclusions The current study showed that painless DPN was associated with poor sleep quality. Future studies are required to clarify the pathophysiologic causal relationship between painless DPN and sleep quality. References 1. Gore M, Brandenburg NA, Dukes E, Hoffman DL, Tai K-S, Stacey B. Pain severity in diabetic peripheral neuropathy is associated with patient functioning, symptom levels of anxiety and depression, and sleep. Journal of pain and symptom management. 2005;30(4): 374-385. 2. Zelman DC, Brandenburg NA, Gore M. Sleep impairment in patients with painful diabetic peripheral neuropathy. Clin J Pain. 2006;22(8): 681-685.

scholarly journals The Association between Sleep Quality and Type Two Diabetes at 20 Year Follow-up in the Southall And Brent REvisited (SABRE) Cohort: a Tri-ethnic Analysis

2020 ◽  
Author(s):  
Zhen Ling Ong ◽  
Nishi Chaturvedi ◽  
Therese Tillin ◽  
Caroline Dale ◽  
Victoria Garfield
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Sleep Quality ◽  
South Asians ◽  
Diabetes Risk ◽  
Poor Sleep ◽  
Falling Asleep ◽  
Traditional Risk Factors

Objective: The risk of developing type 2 diabetes associated with poor sleep quality is comparable to that of traditional risk factors (e.g. overweight, physical inactivity). In the United Kingdom, these traditional risk factors could not explain the two to three-fold excess risks in South Asian and African Caribbean men compared to Europeans. This study investigates the (i)the association between mid-life sleep quality and later-life type 2 diabetes risk and (ii)a potential modifying effect of ethnicity. Research Design and Methods: The Southall and Brent REvisited (SABRE) cohort comprised Europeans, South Asians, and African Caribbeans (median follow-up = 19 years). Complete case analysis was performed on 2190 participants without diabetes at baseline (age= 51.7 ± 7SD). Competing risks regressions were used to estimate the hazard ratios (HRs) of developing type 2 diabetes associated with four self-reported baseline sleep exposures (difficulty falling asleep, early morning waking, waking up tired and snoring) while adjusting for confounders. Modifying effects of ethnicity were analysed by (i) testing for interactions and (ii) performing ethnicity-stratified analysis. Results: Snoring was strongly associated with increased type 2 diabetes risk but only among South Asians in a fully-adjusted model (HR 1.42, 95%CI=1.08-1.85, P=0.011). Our results revealed no elevated risk for any of the sleep exposures across all three ethnic groups. Conclusions: The association between snoring and type 2 diabetes appeared to be modified by ethnicity, with South Asians at greatest risk.

scholarly journals 1056 Perceived Financial Difficulty Predicts Sleep Quality In Participants With Type 2 Diabetes And Obstructive Sleep Apnea

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A401-A401
Author(s):  
J L Morris ◽  
L Baniak ◽  
S M Belcher ◽  
C Imes ◽  
F Luyster ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Obstructive Sleep Apnea ◽  
African American ◽  
Sleep Quality ◽  
Disease Severity ◽  
Poor Sleep ◽  
Financial Difficulty ◽  
Poor Sleep Quality ◽  
Obstructive Sleep

Abstract Introduction People with multiple chronic conditions such as type 2 diabetes (T2D) and obstructive sleep apnea (OSA) are at increased risk for poor sleep quality. It is unclear if social determinants of health (SDoH) such as race, perceived financial difficulty, education, gender, and marital status are associated with sleep quality in this population. The purpose of this cross-sectional secondary analysis of data from the Diabetes Sleep Treatment Trial was to explore SDoH and disease severity as predictors of sleep quality in persons with both OSA and T2D. Methods Disease severity was measured by Apnea-Hypopnea Index [(AHI) ≥ 5] and A1C for glycemic control. SDoH included perceived financial difficulty (none/moderate-severe), race (White/African American), sex (f/m), marital status (no/yes), education (≤ or &gt; 2 years post high school), and age. Sleep quality was measured by Pittsburgh Sleep Quality Index (PSQI). Correlations and linear regression modeling investigated associations between SDoH and disease severity on sleep quality. Post-hoc correlations were explored for significant relations among SDoH. Results The sample (N = 229) was middle-aged (57.6 ± 10.0; 66 % White and 34% African American; and 54 % men vs. 46% women. Participants carried a high burden of disease (mean AHI = 20.7±18.1, mean A1C = 7.9 %±1.7%). Disease severity was not significantly associated with sleep quality (all p &gt;.05). The perception of worse financial difficulty was the only SDoH that predicted worse sleep quality (b=-1.54, p=.015). Characteristics significantly associated with worse financial difficulty were being African American, female, ≤ 2 years post high school, and younger (all p&lt;.01). Conclusion Financial difficulty may be a more important predictor of subjective measures of sleep quality than disease severity in patients with OSA and T2D. Researchers and clinicians should be aware of these characteristics as potential markers of vulnerability to poor sleep quality in this population. Support The National Institute of Diabetes and Digestive and Kidney Diseases (R01DK096028) and through the Clinical +Translational Research Institute grants UL1TR001857 and UL1TR000005.

scholarly journals Sleep quality among type 2 diabetes mellitus patients in a private hospital setting in Yangon, Myanmar

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Hnin Nandar Htut ◽  
Nopporn Howteerakul ◽  
Nawarat Suwannapong ◽  
Petch Rawdaree
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Sleep Quality ◽  
Family Relationships ◽  
Private Hospital ◽  
Poor Sleep ◽  
Poor Sleep Quality ◽  
Content Type

PurposeThis study aimed to assess the sleep quality and its associated factors among patients with type 2 diabetes mellitus (T2DM) in a private hospital in Yangon, Myanmar.Design/methodology/approachA cross-sectional study was conducted. A total of 289 T2DM patients were interviewed using a structured questionnaire. An English version of the Pittsburgh Sleep Quality Index (PSQI) was translated into Myanmar and used for assessing sleep quality.FindingsApproximately 48.4% of T2DM patients had poor sleep quality (PSQI score > 5). The mean ± SD of the PSQI global score was 5.97 ± 3.45. About 36.0% of participants reported the presence of diabetes complications, and 14.9% used sleep medication. About 27.7% had depression and 8.3% had poor family relationships. Multiple logistic regression analysis revealed that the presence of complications (AOR = 1.86; 95%CI; 1.04–3.35), poor family relationships (AOR = 5.09; 95%CI; 1.55–16.68) and depression (AOR = 7.52; 95%CI; 3.83–14.76) were significantly associated with poor sleep quality.Originality/valueThe prevalence of poor sleep quality is rather high among T2DM patients. Healthcare personnel and hospital administrators should focus on the complication status, family relationships and depression status of T2DM patients by providing regular screening for sleep quality and depression and by providing a program of sleep health education and counselling at diabetic clinics

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