Circadian characteristics of the rest-activity rhythm, executive function, and glucose fluctuations in young adults with type 1 diabetes

ABSTRACT

Circadian alignment is an important element in individual health, and one behavioral marker, rest-activity rhythm, could influence self-management in young adults with type 1 diabetes (T1D). Little is known about the rest-activity rhythms, executive function, and glycemia among young adults with type 1 diabetes (T1D). The purpose of this study was to evaluate parametric and nonparametric circadian characteristics of the rest-activity rhythm and the associations between these variables, sleep-wake behavior, executive function, and glycemia among young adults with T1D. Young adults with T1D, recruited from diabetes clinics, wore wrist actigraphs and a continuous glucose monitor (CGM) concurrently for 6–14 days. Participants completed a 3-minute Trail Making Test on paper and electronic questionnaires – 8-item PROMIS v1.0 Emotional Distress Scale, 17-item Diabetes Distress Scale, including twice-daily Pittsburgh sleep diaries. Cosinor and nonparametric analyses were used to compute the rest-activity rhythm parameters, and linear regression modeling procedures were performed to determine the associations among the study variables. The sample included 46 young adults (mean age 22.3 ± 3.2; 32.6% male; 84.8% non-Hispanic White, HbA1c mean 7.2 ± 1.1%, BMI mean 27.0 ± 4.4 kg/m²). A number of parametric associations were observed between a stronger rhythm, better objective sleep-wake characteristics, and less daytime sleepiness. Nonparametric circadian parameters were significantly associated with several outcomes: a stronger rhythm adherence (higher inter-daily stability) with better objective sleep-wake characteristics, better executive function, lower diabetes distress, less hyperglycemia risk, and more time spent in hypoglycemia/hypoglycemia risk; and a more robust rhythm (higher relative amplitude) with better objective sleep-wake characteristics and more time spent in hypoglycemia/higher hypoglycemia risk. Future work should be directed at designs that test causality, such as interventions directed at the strength and stability of rest-activity rhythms, for the potential to improve glucoregulation and other diabetes outcomes.

KEYWORDS:

• Circadian rest-activity rhythm
• sleep
• type 1 diabetes
• cosinor analysis
• actigraphy
• diabetes self-management
• young adult

Disclosure statement

The authors report no potential competing interest.

Additional information

Funding

This material is based upon work partially supported by the American Academy of Sleep Medicine Foundation (AASM), 220-BS-19, and the National Institute for Nursing Research (NINR), K99NR018886. Any opinions, findings, and conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the AASM Foundation or NIH. SG was previously funded by NINR T32NR0008346, and Sigma Theta Tau International provided research support for the study. Dexcom provided continuous glucose monitors (G4) free of charge to be used in the study for participants who did not have a device