Eating habits and sleep quality in individuals with type 1 diabetes on continuous glucose monitoring and insulin pump.

None

Individuals with T1D commonly have sleep disorders and this is linked to poor diet choices, particularly at dinner, independent of blood glucose control. However, sleep quality is influenced by an overall healthy lifestyle including specific food and nutrient intake.

Introduction

Sleep disorders are bidirectionally linked to obesity and abnormalities in glucose metabolism.

Methods

This cross-sectional study asked T1DM participants (n=117) to provide a 7-day food diary, anthropometrics and a prior 12-month dietary assessment. Sleep quality was assessed using the PSQI self-report questionnaire.

Results

• Bad Sleepers (n=81) were twice as prevalent as Good Sleepers (n=36), had higher intakes of total fat (60.1 ± 20.0 vs. 51.1 ± 19.0 g, p = 0.031) and polyunsaturated fat (4.7 ± 1.2 vs. 4.2 ± 1.0 % of total energy, p = 0.016).
• Bad Sleepers had dinners with higher energy intakes (679.2 ± 206.5 vs. 582.1 ± 203.1 kcal, p = 0.027), fat intake (30.7 ± 10.7 vs. 24.0 ± 10.5 g, p = 0.004), saturated (12.1 ± 4.6 vs. 10.1 ± 3.1 %, p = 0.010) and polyunsaturated fats (5.1 ± 1.8 vs. 4.4 ± 1.2 %, p = 0.020).
• Long Sleep Onset Latency (SOL) individuals had higher dinner fat intakes (31.1 ± 11.8 vs. 26.1 ± 9.8 g, p = 0.022) versus Short SOL individuals, and higher intakes of vegetable oils (14.9 ± 5.0 vs. 13.0 ± 4.2 g/1000 kcal, p = 0.029).
• Short Sleepers had significantly higher intake of coffee, tea (90.4 ± 71.7 vs. 62.0 ± 35.6 g/1000 kcal, p = 0.006), alcoholic drinks (47.8 ± 51.1 vs. 28.9 ± 31.5, g/1000 kcal, p = 0.015) and carbonated soft drinks (21.8 ± 38.1 vs. 9.3 ± 17.2 g/1000 kcal, p = 0.018).
• A direct correlation was observed between sleep duration and legume & meat intake (p=0.038, p=0.018 respectively).

Conclusion

High saturated fat, alcohol, caffeine, carbonated drinks are associated with poor sleep. Dinner composition has particular influence on sleep quality.

• Poor sleep is common in individuals with T1D as seen in this cohort. All participants, good and bad sleepers, had excess daily intake of simple sugar, total and saturated fats and inadequate fibre intake. Assessment of these factors when working with type 1 diabetics is important.
• Dietary composition, particularly at dinner, can influence sleep in type 1 diabetics. This includes high energy and fat content, alcohol, caffeine and carbonated drinks.
• Given the above, a thorough diet and lifestyle review, use of 7-day food diaries and diet tracking apps could help when working with these individuals.
• These findings were independent of post-dinner blood glucose concentrations therefore it is worth thinking of the influence of other mechanisms at play.
• The cause-effect relationship between sleep, fat intake and body weight is unclear. In this study BMI was the main predictor of sleep duration and fat intake the main predictor of overall sleep quality.
• Energy-dense meals are often consumed with alcohol and/or carbonated drinks. These factors are important to consider when working with such individuals.

• Due to the cross-sectional design of this study, cause-effect conclusions cannot be drawn between sleep quality and dietary habits, and bias due to self-reporting is possible.
• A randomised controlled trial over a longer duration in this population and within a controlled environment could help better understand the underlying mechanisms at play. This could include controlling meal composition as well as in-person post-prandial glucose response and sleep monitoring.
• Both groups had excess intake of sugars, fat and inadequate fibre intake. Comparing to a group with intakes within the recommended guidelines would be helpful.
• There are many different types of fat and saturated fat with differing impacts on health. Better defining this in the study design could help to draw specific actionable conclusions.