Lan Rui, Mao Lina, Luo Tingting, Luo Wenjin, Qin Yao, Ye Hanwen, Hu Jingbo, Yang Shuming, Li Qifu, Wang Zhihong, Chen Xiangjun
Department of Clinical Nutrition, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China.
Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
J Diabetes. 2025 Jul;17(7):e70107. doi: 10.1111/1753-0407.70107.
The association of sleep behaviors with microvascular complications and cardiovascular outcomes in diabetic patients is not clear. Furthermore, serum biomarkers that can be used to evaluate this association have not been characterized. Therefore, this study investigated the association of the overall sleep score with the diabetic complications and the potential underlying serum metabolic biomarkers in patients with type 2 diabetes mellitus (T2DM).
This prospective cohort study included 30 915 T2DM patients without complications from the UK Biobank. The sleep score of the participants was evaluated based on sleep behaviors such as sleep duration, insomnia, snoring, chronotype, and daytime sleepiness. The potential biomarkers, including cystatin C (Cys C), apolipoprotein A (Apo A), C-reactive protein (CRP), albumin, and γ-glutamyl transpeptidase (GGT), were also determined to evaluate their role as potential indicators of the association between the sleep score and the diabetic complications.
Participants with a healthy sleep score of 4-5 had lower risks of microvascular complications (HR = 0.80 [95% CI: 0.72, 0.89]) and cardiovascular outcomes (HR = 0.70 [95% CI: 0.61, 0.81]) compared to those with a sleep score of 0-1. Furthermore, cys C showed the best effects by explaining the associations of overall healthy sleep behaviors with microvascular complications and cardiovascular outcomes by 30.36% and 14.36%, respectively.
Our data showed that healthy sleep behaviors were associated with a reduced risk of diabetic complications. Moreover, serum biomarkers of renal function, lipids, systemic inflammation, and hepatic function partially mediated the relationship between sleep behaviors and diabetic complications.
糖尿病患者的睡眠行为与微血管并发症及心血管结局之间的关联尚不清楚。此外，可用于评估这种关联的血清生物标志物尚未得到明确。因此，本研究调查了2型糖尿病（T2DM）患者的总体睡眠评分与糖尿病并发症之间的关联以及潜在的血清代谢生物标志物。
这项前瞻性队列研究纳入了英国生物银行中30915例无并发症的T2DM患者。根据睡眠时间、失眠、打鼾、昼夜节律类型和日间嗜睡等睡眠行为对参与者的睡眠评分进行评估。还测定了包括胱抑素C（Cys C）、载脂蛋白A（Apo A）、C反应蛋白（CRP）、白蛋白和γ-谷氨酰转肽酶（GGT）在内的潜在生物标志物，以评估它们作为睡眠评分与糖尿病并发症之间关联的潜在指标的作用。
睡眠评分为4-5分的健康参与者与睡眠评分为0-1分的参与者相比，微血管并发症（HR = 0.80 [95% CI：0.72, 0.89]）和心血管结局（HR = 0.70 [95% CI：0.61, 0.81]）的风险更低。此外，胱抑素C表现出最佳效果，分别解释了总体健康睡眠行为与微血管并发症和心血管结局之间关联的30.36%和14.36%。
我们的数据表明，健康的睡眠行为与糖尿病并发症风险降低有关。此外，肾功能、血脂、全身炎症和肝功能的血清生物标志物部分介导了睡眠行为与糖尿病并发症之间的关系。
