Insomnia and incident risk of diabetes related complications in Hong Kong Chinese patients with type 2 diabetes
Refereed conference paper presented and published in conference proceedings


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AbstractBackground and aims:
Insomnia is associated with worse glycaemic control in patients with type 2 diabetes (T2D). However, whether insomnia has impact on the development of diabetes related complications is under-explored. We hypothesized that insomnia might be associated with increased risk of incident clinical endpoints. Here, we tested the hypothesis by examining the associations between insomnia and incident clinical endpoints in patients with T2D.

Materials and methods:
Participants of the Hong Kong Diabetes Register were assessed for sleep habits and insomnia by questionnaires between July 2010 and June 2015 and were prospectively followed up for outcomes. Insomnia was defined as the Insomnia Severity Index score > 14. Clinical outcomes including incident cardiovascular disease (CVD), chronic kidney disease (CKD), end-stage renal disease (ESRD), cancer and all-cause death were censored on 30th June 2017.

Results:
Among 3407 patients with T2D [mean (standard deviation) age was 54.4 (8.5) years, 57.5% were men], 9.5% had insomnia. Compared to T2D without insomnia, T2D with insomnia had more women (52.2 vs 41.5%), anxiety/depressive symptoms (51.6 vs 15.4%), habitual snoring (44.5 vs 34.9%), worse glycaemic control [glycated haemoglobin, HbA1c 7.72 (1.74) vs 7.50 (1.46) %; fasting plasma glucose 7.91 (3.21) vs 7.54 (2.37) mmol/l] despite the fact that there were a higher percentage of T2D with insomnia were put on insulin treatment (31.1 vs 24.6%) than those without insomnia (all p<0.05). At baseline, T2D with insomnia had a higher percentage of sensory neuropathy (7.5 vs 3.2%, p<0.001) and macroalbuminuria (13.1vs 9.2%, p=0.024)

We excluded snorers (n=1360) who might have obstructive sleep apnoea. Among 2047 non-snorers, after a mean follow-up of 4.74 (1.22) years, T2D with insomnia had a higher incidence of ESRD (1.51% versus 0.50%, p = 0.001) than T2D without insomnia. After adjusted for potential confounders including age, sex, disease duration of diabetes, HbA1c, low density lipoprotein cholesterol, triglyceride, body mass index, blood pressure, mean sleep duration, anxiety and depression, smoker and drinking habits and medications (anti-diabetic drugs, insulin, anti-hypertensives and lipid-lowering agents), insomnia remained to be significantly associated with increased risk of incident ESRD in patients with T2D (Hazard ratio, HR 2.36, 95% confidence interval, CI 1.02-5.45, p=0.044). However, the effect became attenuated after further adjustment for macroalbuminuria and sensory neuropathy (HR 1.99, 95% CI 0.83-4.75, p=0.121).

Conclusion:
T2D patients with co-morbid insomnia may have increased risk of ESRD when compared to their counterparts without insomnia. Our findings suggest a possible link between mental and physical health and call for a holistic approach to improving diabetes care. Long-term prospective studies including T2D with insomnia but without complications at baseline would be required to examine the impact of insomnia on the development of diabetic complications.
Acceptance Date14/06/2018
All Author(s) ListChenzhao Ding, Jihui Zhang, Eric Siu Him Lau, Andrea On Yan Luk, Elaine Chow, Ronald Ching Wan Ma, Juliana Chung Ngor Chan, Yun Kwok Wing, Alice Pik Shan Kong
Name of Conference54th Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD)
Start Date of Conference01/10/2018
End Date of Conference05/10/2018
Place of ConferenceBerlin
Country/Region of ConferenceGermany
Proceedings TitleDIABETOLOGIA
Year2018
Month10
Volume Number61
Issue NumberSupp 1
PagesS159 - S160
ISSN0012-186X
eISSN1432-0428
LanguagesEnglish-United Kingdom
KeywordsEpidemiology

Last updated on 2020-30-09 at 00:52