Association between sleep-related symptoms and type 2 diabetes

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Midlife women with type 2 diabetes mellitus (T2DM) are at a significantly higher risk of sleep-related symptoms, according to a study in the journal Menopause.

The study is a secondary analysis of data from 164 participants of two Internet-based studies which examined racial/ethnic differences in menopausal symptoms and attitudes toward physical activity among  four major racial/ethnic groups of midlife women in the United States: Hispanic, non-Hispanic white, non-Hispanic African American and non-Hispanic Asian.

All study participants were between ages 40 and 60 and were literate in English.

The analysis was limited to data collected in the original two studies, which relied on answers from participants about background characteristics, health status, menopause status and the Sleep Index for Midlife Women (SIMW).

The SIMW, a subscale of the Midlife Women’s Symptom Index (MSI), asks 24 questions on symptoms. Individual items include a frequency scale (yes or no) and a severity scale from 0 (no symptoms) to 5 (extremely), with higher scores representing more frequent and severe symptoms.

Among the 62 women diagnosed with T2DM and the 102 women without diabetes, the mean total number of sleep-related symptoms was 8.27 (standard deviation [SD] = 6.11; range 0 - 24), whereas the mean total severity score of sleep-related symptoms was 26.24 (SD = 22.43; range 0 – 99).

However, the mean total number of sleep-related symptoms was significantly higher in women with T2DM: 9.95 vs. 7.25 (P = 0.006).  

Mean total severity score of sleep-related symptoms was also higher in those with T2DM: 33.42 vs. 21.87 (P = 0.001).

In addition, among postmenopausal women, those with T2DM had significantly higher total numbers of (P = 0.013) and total severity scores for (P = 0.005) sleep-related symptoms compared to those without T2DM (P <  0.05).

But in premenopausal and perimenopausal women, these differences were not statistically significant (P >  0.05).

The analysis also found that among postmenopausal women and Asian women, there were significant differences in total numbers and total severity scores between those with T2DM and those without diabetes (all P <  0.05).

For instance, non-Hispanic Asian women with T2DM had dramatically higher total numbers of (P = 0.015) and total severity scores for (P = 0.010) sleep-related symptoms compared to those without T2DM (P >  0.05).

Conversely, there were no significant differences in total numbers and total severity scores for the other three racial/ethnic groups, when comparing those with T2DM to those without.

Overall, a diagnosis of T2DM was positively linked to the total numbers of (P = 0.047) and total severity scores for (P = 0.014)  sleep-related symptoms.

“Sleep disturbances during the menopausal transition could make those with T2DM require an additional dimension of care,” said the study authors from the School of Nursing at both Duke University and the University of Pennsylvania. “For instance, sleep disturbances during the menopausal transition could make women feel excessive daytime fatigue, perceive it as a sign of hypoglycemia, and eat extra calories, which subsequently increases their blood glucose.”

Likewise, medications for T2DM may cause sleep-related symptoms in midlife women with T2DM, with one of the side effects of metformin being sleep difficulties.

Individuals with T2DM are also at increased risk of developing restless leg syndrome, which causes sleep-related symptoms, perhaps related to neuropathy in this population.