Sleep health linked to type 2 diabetes risk in women with gestational diabetes

Sleep health linked to type 2 diabetes risk in women with gestational diabetes | Image Credit: © StockPhotoPro - © StockPhotoPro - stock.adobe.com.

The risk of type 2 diabetes (T2D) is increased among women with gestational diabetes (GD) sleeping less and snoring occasionally or regularly, according to a recent study published in JAMA Network Open.¹

Sleep issues and T2D risk

According to the Centers for Disease Control and Prevention, 1 in 3 US adults sleep less than 7 hours per day. Sleep health has been linked to multiple adverse outcomes such as cancer, dementia, and potentially T2D. The risk of T2D is also increased among women with GD, which impacts 2% to 30% of pregnancies worldwide.²

“Women diagnosed with GD are nearly 10 times more likely to develop T2D later in life than those without a GD history,” wrote investigators.¹ “Therefore, it is imperative to identify modifiable lifestyle factors related to the progression from GD to T2D.”

To evaluate the link between sleep characteristics and long-term T2D risk among women with GD, investigators conducted a cohort study. Women in the Nurses’ Health Study II (NHSII) with a history of GD were included in the analysis.

The NHSII included female nurses aged 24 to 44 years, recruited in 1989. Health-related behaviors and disease outcomes were obtained from self-reported questionnaires, including health status and lifestyle factors reported every 2 to 4 years.

Study design

Women with a history of GD reporting sleep characteristics in the NHSII 2001 questionnaire were included in the current analysis. Race and ethnicity data was also reported.

Sleep characteristics reported included how much participants slept per day and whether they snored. Snoring categories included almost never at 0 nights per week, occasionally at 1 to 2 nights per week, and regularly at 3 or more nights per week. Sleep duration categories included 6 or fewer, 7, 8, and 9 or more hours per day.

Daytime sleepiness was also reported, with categories including 0 days per week, 1 to 3 days per week, and at least 4 days per week. T2D data was collected through the biennial questionnaires and included symptoms, diagnostic tests, and hypoglycemic therapy.

Diabetes was confirmed through the presence of at least 1 American Diabetes Association criteria. Glycated hemoglobin (HbA1c), insulin, and C-peptide levels were measured as biomarkers of diabetes.

Study findings and implications

There were 2891 women with GD history aged a mean 45.3 years included in the analysis, 19.5% of whom reported T2D during follow-up. Of participants, 92.7% were White while 7.3% were other race or ethnicity.

Patients who snored regularly at baseline were more likely to smoke, have a respiratory illness, and use medications that impact sleep vs those who never snored. Those with shorter sleep durations were more often postmenopausal, night shift workers, or had a higher body mass index (BMI), caffeine intake, or depression.

A significant association was reported between snoring and T2D, with a hazard ratio (HR) of 2.17 for occasional snoring and 2.66 for regular snoring when compared to never snoring after adjusting for covariates. When further adjusting for BMI, these HRs were 1.54 and 1.61, respectively.

Sleeping for 6 hours or less per night was also significantly associated with future T2D vs sleeping for 7 or 8 hours, with an HR of 1.32. However, no link was reported between sleeping for 9 or more hours per night and T2D.

An HR of 1.50 was reported for T2D among women with daytime sleepiness 4 or more days per week vs those rarely or never experiencing daytime sleepiness. However, this association did not remain when adjusting for covariates beyond age.

Significantly increased HbA1c levels were reported among women snoring regularly vs those never snoring, at 5.89 vs 5.77, respectively. C-peptide and insulin levels were also increased among women snoring regularly. Overall, sleep duration and frequent snoring were linked to future T2D risk among women with a history of GD.

“These findings underscore the importance of sleep health, particularly for this high-risk population,” wrote investigators. “Prevention strategies for progression from GD to T2D should incorporate sleep health, emphasizing the monitoring of sleep duration and snoring.”

Reference

1. Yin X, Bao W, Ley SH, et al. Sleep characteristics and long-term risk of type 2 diabetes among women with gestational diabetes. JAMA Netw Open. 2025;8(3):e250142. doi:10.1001/jamanetworkopen.2025.0142
2. McIntyre HD, Catalano P, Zhang C, Desoye G, Mathiesen ER, Damm P. Gestational diabetes mellitus.Nat Rev Dis Primers. 2019;5(1):47. doi:10.1038/s41572-019-0098-8