Use of continuous glucose monitoring (CGM) devices positively correlated with fewer sleep disturbances in children with type 1 diabetes (T1D) but higher sleep disturbances in their parents, according to results of a study published in Diabetes Technology & Therapeutics.
Studies have shown that children with T1D experience a higher frequency of sleep disturbances and that poor sleep quality is associated with higher hemoglobin A1c. Few studies have examined health-related quality of life (HRQoL) as an outcome of sleep disturbance in young children with T1D. The effect of CGM in young children on sleep disturbance also has yet to be evaluated.
To investigate the relationship between sleep quality, CGM use, and HRQoL in children with T1D and their parents, data from 46 parent-child dyads (89.1% mothers; 67.3% non-Hispanic white; 36.9% female child; 63.0% CGM use) were analyzed. Children aged 2 to 5 years who had been diagnosed with T1D for >1 year were considered eligible. The average age of all participating parents was 36.5±6.2 years, and the average age of all participating children was 4.7±0.9 years. In addition, 11 parent-child dyads (90.9% mothers; 81.8% non-Hispanic white; 45.5% female child; 100% CGM use) agreed to provide overnight accelerometer data for their children. For this subset, the average age of parents was 39±4.5 years and the average age of children was 4.7±0.5 years.
All participating parents completed a series of psychological questionnaires for themselves and for their children, as well as a report of their child’s sleep schedule and nighttime blood glucose monitoring routine. Blood glucose level data were downloaded from the patients’ monitors. All children who provided accelerometer data wore the device for a minimum of 4 nights.
Children who used CGM experienced fewer sleep disturbances than those who did not, according to parent reports (P <.01), although parents of children who used CGM experienced greater sleep disturbances than parents of children who did not (P <.01), related to a higher frequency of nighttime blood glucose monitoring (P <.05) compared with CGM nonusers. There were no significant differences in parent or child HRQoL between CGM users and nonusers. There were also no associations between objective measures of sleep and nighttime blood glucose monitoring or HRQoL for the subset of parents and children who participated in the accelerometer portion of the study.
Child daytime tiredness correlated significantly with child HRQoL as related to treatment adherence (r=0.97; P =.03). Child sleep disturbance from nighttime blood glucose monitoring significantly correlated with greater difficulties related to diabetes symptoms (r=-0.96; P =.04) and treatment adherence (r=-0.99; P =.01).
Although past studies have shown shorter sleep duration in children with T1D, this study did not find a notable sleep deficit in this group of patients. This study showed HRQoL in children and parents was affected only when children were tired during the day, which parents attributed to sleep disruption due to blood glucose monitoring the night before. “It is possible that CGM use may assist child sleep duration by minimizing their wake periods throughout the night, given that parents are less likely to wake their child up for [nighttime blood glucose monitoring],” the researchers noted.
A limitation of this study was its use of self-reported information, which may have resulted in inaccurate data. For example, parents in the full sample reported their child’s total sleep time to be an average of 10.4±0.76 hours. Accelerometer data from a subset of participants measured a total sleep time of 9.8±0.84 hours, approximately 30 minutes less than what parents of these children reported.
Whereas children in the sample were shown to be getting adequate sleep, parent sleep duration might be more negatively affected by the diabetes management of their children, which warrants further study. Future studies should further explore the relationship between sleep and technology use and the effect on clinical outcomes in young children with T1D and their parents. Moreover, the findings related to nighttime blood glucose monitoring should be further clarified to better understand if parent sleep disturbance results from CGM alarms or from conducting finger pricks.
Sinisterra M, Hamburger S, Tully C, Hamburger E, Jaser S, Streisand R. Young children with type 1 diabetes: sleep, health-related quality of life, and continuous glucose monitor use [published online March 2, 2020]. Diabetes Technol Ther. doi: 10.1089/dia.2019.0437