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. 2024 May:117:209-215.
doi: 10.1016/j.sleep.2024.03.015. Epub 2024 Mar 14.

Type 2 diabetes and health-related quality of life among older Medicare beneficiaries: The mediating role of sleep

Marie-Rachelle Narcisse  1 , Pearl A McElfish  2 , Mario Schootman  2 , James P Selig  3 , Tracie Kirkland  4 , Samy I McFarlane  5 , Holly C Felix  6 , Azizi Seixas  7 , Girardin Jean-Louis  7
Affiliations

Type 2 diabetes and health-related quality of life among older Medicare beneficiaries: The mediating role of sleep

Marie-Rachelle Narcisse et al. Sleep Med. 2024 May.

Abstract

Objective: To examine mediating effects of sleep quality and duration on the association between T2D and QoL among Medicare beneficiaries 65+.

Methods: Data from the Medicare Health Outcome Survey (2015-2020) were used. The outcome was QoL (physical and mental health component-summary scores [PCS and MCS]) measured by the Veterans-Rand-12. The main predictor was diagnosed T2D. Mediators were sleep duration and sleep quality. The effect modifier was race/ethnicity. Structural Equation Modeling was used to estimate moderated-mediating effects of sleep quality and duration across race/ethnicity.

Results: Of the 746,400 Medicare beneficiaries, 26.7% had T2D, and mean age was 76 years (SD ± 6.9). Mean PCS score was 40 (SD ± 12.2), and mean MCS score was 54.0 (SD ± 10.2). Associations of T2D with PCS and MCS were negative and significant. For all racial/ethnic groups, those with T2D reported lower PCS. For White, Black, Asian, and Hispanic beneficiaries only, those with T2D reported lower MCS. The negative impact of T2D on PCS and MCS was mediated through sleep quality, especially very bad sleep quality.

Conclusion: Improving sleep may lead to improvement in QoL in elderly adults with T2D.

Keywords: Mediation-moderation analysis; Medicare beneficiaries; Medicare health outcomes survey; Older adults; Quality of life; Racial/ethnic disparities; Sleep duration; Sleep quality; Type 2 diabetes.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1.
Figure 1.
Conceptual Framework: A Mediation-Moderation Model Linking Type 2 Diabetes to Quality of Life Sleep duration and quality are the mediators. Race/ethnicity is the moderating variable. Other covariates (e.g., sex, age, education, marital status, homeowner status, income, family structure, and other chronic conditions) not shown
See this image and copyright information in PMC

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