Sweet dreams or bitter nightmare: a narrative review of 25 years of research on the role of sleep in diabetes and the contributions of behavioural science

• Published in: Diabetic medicine 2020-03, Vol.37 (3), p.418-426
• Main Authors: Nefs, G.M., Bazelmans, E., Donga, E., Tack, C. J., Galan, B. E.
• Format: Article
• Language: English
• Subjects: Cognition; Diabetes; Diabetes mellitus (insulin dependent); Diabetes mellitus (non-insulin dependent); Dreams; Glucose tolerance; Health behavior; Insulin; Medical research; Mood; Sleep; Sleep disorders; Sweet taste
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.14211

The aim of this review was to provide an overview of developments, clinical implications and gaps in knowledge regarding the relationship between diabetes and sleep over the past 25 years, with special focus on contributions from the behavioural sciences. Multiple prospective observational and experimental studies have shown a link between suboptimal sleep and impaired glucose tolerance, decreased insulin sensitivity and the development of type 2 diabetes. While prevalence rates of suboptimal sleep vary widely according to definition, assessment and sample, suboptimal subjective sleep quality appears to be a common reality for one‐third of people with type 1 diabetes and over half of people with type 2 diabetes. Both physiological and psychosocial factors may impair sleep in these groups. In turn, suboptimal sleep can negatively affect glycaemic outcomes directly or indirectly via suboptimal daytime functioning (energy, mood, cognition) and self‐care behaviours. Technological devices supporting diabetes self‐care may have both negative and positive effects. Diabetes and its treatment also affect the sleep of significant others. Research on the merits of interventions aimed at improving sleep for people with diabetes is in its infancy. Diabetes and sleep appear to be reciprocally related. Discussion of sleep deserves a central place in regular diabetes care. Multi‐day, multi‐method studies may shed more light on the complex relationship between sleep and diabetes at an individual level. Intervention studies are warranted to examine the potential of sleep interventions in improving outcomes for people with diabetes. What's new? In 1994, studying suboptimal sleep in people with diabetes was highlighted as a promising new research area. Since then, a large evidence base has illustrated the myriad of ways in which sleep and diabetes are linked. Suboptimal sleep is a common reality for many people with diabetes, which may negatively impact glycaemic and psychosocial outcomes. In turn, physiological and psychosocial factors may impair sleep. Sleep deserves a more central place in regular diabetes care. Future studies may focus on clarifying the interactions of sleep and diabetes on the individual level, as well as on evaluating the merits of sleep interventions in this group.