Hot Topic April 2022: New Study Examines Impact of Sleep Quality on Dysregulated Blood Glucose Control

A man sleeping soundly in bed


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Metabolic homeostasis relies, in part, on balanced sleep patterns and a balanced diet,1 with research suggesting that sleep abnormalities are causally linked to diseases such as CVD, obesity, type 2 diabetes,2 and impairments in glucose homeostasis.1 Epidemiological and experimental studies have demonstrated that sleep quality and quantity are important determinants of whole-body metabolism,2 and that circadian rhythms may influence cardiometabolic diseases.3-5 For example, subjectively perceived insufficient, poor, or short sleep is associated with several pre-diabetic features such as fasting hyperglycemia, elevated postprandial glucose, and insulin levels or indices of whole-body insulin resistance.2 Inadequate sleep has also been shown to be detrimental in patients who have already developed diabetes since it negatively impacts glycemic control.2

The relationship between sleep and blood sugar is complex, however, and one-size-fits-all sleep recommendations can be suboptimal, particularly in the context of postprandial glycemic control.1 With this in mind, a team of researchers in 2022 studied the effects of insufficient sleep on blood glucose control by asking the key question: do night-to-night fluctuations in sleep duration, efficiency, or timing impact postprandial glucose response to breakfasts (of varying macronutrient composition) the following day?1

During the study, 1,102 generally healthy adults from the UK and US were given standardized test meals of different nutritional composition.1 The meals were consumed either for breakfast or lunch in a randomized meal order and consisted of eight different standardized meals: (1) metabolic challenge meal; (2) medium fat and carb; (3) high fat 35 g; (4) high carb (with low fat and protein); (5) 75 g oral glucose tolerance test (OGTT), consisting of carbohydrates only; (6) high fiber; (7) high fat 40 g; and (8) high protein.1

Participants were asked to consume only their standardized breakfasts after no less than eight hours of fasting and to drink only still water during the fasting period.1 In addition, participants were asked to consume all of their meals within 10 minutes, with the exception of the OGTT, which was to be consumed within five minutes. Participants were also asked to limit physical exercise during the three-hour period following the meal, as well as during the eight-hour fasting period prior to its consumption.1

Target variables were as follows: (1) sleep duration or total sleep period time (SPT); (2) sleep efficiency (SE), where SE represents the ratio of time asleep to the total SPT; and (3) sleep midpoint, or the middle time point between bedtime and waking up (expressed in hours as a deviation from midnight).1

Specifically, the researchers found no statistically significant association between SPT and glucose; however, they did find a statistically significant interaction between SPT and meal type, with SPT having a negative association with glucose following a high-carbohydrate and high fat breakfast.1 Greater SE was significantly associated with lower glucose, meaning that achieving better than one’s average SE was associated with better postprandial glycemic control the following day. As well, a later sleep midpoint (expressed in hours as a deviation from midnight) was significantly associated with higher glucose. This effect was largely driven by sleep onset (going to bed later) rather than sleep offset (waking up later).1

From this research, the study’s authors concluded that:

  • Poor sleep efficiency and later bedtime routines are associated with more pronounced postprandial glycemic responses to breakfast the following morning.
  • An individual’s deviation from their usual sleep pattern is associated with poorer postprandial glycemic control.1

The study findings complement a body of knowledge around a topic that is of high relevance for diabetes prevention and underscore the importance of sleep as a modifiable lifestyle intervention for the optimal regulation of metabolic health.1 Numerous factors contribute to sleep disruption, ranging from lifestyle and environmental factors to genetics or other medical conditions.6 A close working relationship between clinician and patient can help identify sleep troubles early on so that they may be targeted with behavioral and lifestyle therapies.

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  1. Tsereteli N, Vallat R, Fernandez-Tajes J, et al. Impact of insufficient sleep on dysregulated blood glucose control under standardised meal conditions. Diabetologia. 2022;65(2):356-365. doi:1007/s00125-021-05608-y
  2. Briançon-Marjollet A, Weiszenstein M, Henri M, Thomas A, Godin-Ribuot D, Polak J. The impact of sleep disorders on glucose metabolism: endocrine and molecular mechanisms. Diabetol Metab Syndr. 2015;7:25. doi:1186/s13098-015-0018-3
  3. Van Laake LW, Lüscher TF, Young ME. The circadian clock in cardiovascular regulation and disease: lessons from the Nobel Prize in Physiology or Medicine 2017. Eur Heart J. 2018;39(24):2326-2329. doi:1093/eurheartj/ehx775
  4. Villanueva JE, Livelo C, Trujillo AS, et al. Time-restricted feeding restores muscle function in Drosophilamodels of obesity and circadian-rhythm disruption. Nat Commun. 2019;10(1):2700. doi:1038/s41467-019-10563-9
  5. Slomski A. Circadian timing of medications affects CVD outcomes. JAMA. 2019;322(24):2375. doi:1001/jama.2019.20565
  6. Medic G, Wille M, Hemels ME. Short- and long-term health consequences of sleep disruption. Nat Sci Sleep. 2017;9:151-161. doi:2147/nss.s134864