Poor sleep quality is a predictor of severe hypoglycemia during comprehensive diabetes care in type 1 diabetes

Purpose: Sleep disturbances is common in type 1 diabetes (T1D) and can be associated with poor glycemic control, and possibly hypoglycemia. This study aims to investigate whether poor sleep quality, as assessed by the Pittsburgh Sleep Quality Index (PSQI), was associated with glycemic control or severe hypoglycemia in T1D individuals. Methods: This one-year prospective cohort study included 221 (148 F/63 M) T1D participants (aged ≥ 13 years), receiving intensive insulin therapy. A1C levels were obtained at baseline and during the 12-month follow-up. Incidences of diabetic ketoacidosis (DKA) and severe hypoglycemia were collected. Results: The mean age of participants was 21.4 ± 8.9 years, with a baseline A1C of 9.27 ± 2.61%. Poor sleep quality was reported in 33.0% of participants. A1C levels improved over the one-year follow-up, but there was no significant difference in A1C reduction between those with good vs. poor sleep quality (-0.42 ± 1.73 vs. -0.42 ± 1.67, P = 0.835), nor in DKA incidence (P = 0.466). However, participants with poor sleep quality experienced more SH episodes (6.53 (2.45–17.41) vs. 0 per 100-person year, P = 0.01). After adjusting for age, body mass index, and glucose monitoring, each one-point increase in PSQI score was associated with a higher severe hypoglycemia risk (OR 1.31, 95%CI 1.13–1.52). Poor sleep quality predicted an increased risk of severe hypoglycemia (OR 24.54, 95%CI 1.31-459.29). Conclusion: Poor sleep quality is common in T1D individuals and is a risk factor for incident SH. These findings highlight the importance of incorporating sleep assessment into routine T1D diabetes care and the need of targeted interventions to improve sleep quality in T1D individuals. These findings support the importance of addressing sleep quality in T1D management, particularly in relation to hypoglycemia risk.