Li Mingzhen, Li Daiqing, Tang Yunzhao, Meng Lingling, Mao Cuixiu, Sun Lirong, Chang Baocheng, Chen Liming
Key Laboratory of Hormones and Development (Ministry of Health), Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University , Tianjin, China .
Metab Syndr Relat Disord. 2018 Feb;16(1):13-19. doi: 10.1089/met.2017.0069. Epub 2018 Jan 22.
Our prior study showed that patients with sleep disorders had poor blood pressure (BP), glycemic control, and more severe complications. Therefore, sleep is very important for diabetic control. Our work was to investigate whether individualized diabetes sleep education significantly improve sleep quality and glycemic control in type 2 diabetic patients who sleep after midnight and potential mechanism by a randomized parallel interventional study.
T2D patients were randomly recruited to an intervention or control group. Patients received structured special diabetes sleep education program with 3-month follow-up. Pittsburg Sleep Quality Index (PSQI) was scored for each participant. Demographic data, HbA1c, biochemical, and some hormones were also examined. SPSS 13.0 was used for statistical analysis.
One hundred patients were approached, and 45 were enrolled into our trial. Eventually, 31 patients completed the study. Patients in the intervention group greatly improved their sleep hygiene. After intervention, PSQI scores were lowered significantly (-1.48 ± 0.88 vs. -0.51 ± 0.71, P < 0.001), as well as significant reduction of HbA1c (-1.5 ± 0.55 vs. -1.11 ± 0.47, P < 0.05). Fasting plasma glucose was also lowered significantly. Homeostasis model assessment of insulin resistance was reduced significantly (-1.29 ± 0.97 vs. 1.04 ± 0.91, P < 0.01). Serum concentrations for interleukin (IL)-6, cortisol, and ghrelin were decreased significantly. Ghrelin (coefficients -0.65, P < 0.001), cortisol (coefficients -0.38, P < 0.05), and IL-6 (coefficients 0.452, P < 0.05) were correlated with HbA1c improvement. The change of ghrelin was negatively associated with the improvement of HbA1c.
Diabetes sleep education could improve sleep quality, better blood glucose and BP, and decrease insulin resistance through healthier sleep hygiene. Lower serum concentration of ghrelin might be partly involved in the reduction of HbA1c.
我们之前的研究表明，睡眠障碍患者的血压、血糖控制较差，并发症更严重。因此，睡眠对糖尿病控制非常重要。我们的工作是通过一项随机平行干预研究，调查个体化糖尿病睡眠教育是否能显著改善午夜后入睡的2型糖尿病患者的睡眠质量和血糖控制及其潜在机制。
将2型糖尿病患者随机招募到干预组或对照组。患者接受结构化的特殊糖尿病睡眠教育计划，并进行3个月的随访。对每位参与者进行匹兹堡睡眠质量指数（PSQI）评分。还检查了人口统计学数据、糖化血红蛋白（HbA1c）、生化指标和一些激素。使用SPSS 13.0进行统计分析。
共纳入100例患者，45例进入我们的试验。最终，31例患者完成了研究。干预组患者的睡眠卫生状况有了很大改善。干预后，PSQI评分显著降低（-1.48±0.88对-0.51±0.71，P<0.001），HbA1c也显著降低（-1.5±0.55对-1.11±0.47，P<0.05）。空腹血糖也显著降低。胰岛素抵抗的稳态模型评估显著降低（-1.29±0.97对1.04±0.91，P<0.01）。血清白细胞介素（IL）-6、皮质醇和胃饥饿素浓度显著降低。胃饥饿素（系数-0.65，P<0.001）、皮质醇（系数-0.38，P<0.05）和IL-6（系数0.452，P<0.05）与HbA1c改善相关。胃饥饿素的变化与HbA1c的改善呈负相关。
糖尿病睡眠教育可以通过更健康的睡眠卫生改善睡眠质量，更好地控制血糖和血压，并降低胰岛素抵抗。血清胃饥饿素浓度降低可能部分参与了HbA1c的降低。
