Adherence to the Mediterranean diet and sleep quality are inter-correlated with flash glucose monitoring (FGM)-measured glycemia among children with type 1 diabetes

Abstract

Background: We examined the inter-correlation between diet quality, objectively measured sleep duration, and subjectively measured sleep quality with flash glucose monitoring (FGM)-measured glycemia among young patients with type 1 diabetes (T1D).

Materials and methods: Following cross-sectional design, Fitbit^® accelerometers were used to objectively assess sleep duration, while the validated questionnaires Pittsburgh sleep quality index and Mediterranean diet (MD) adherence were used to subjectively assess sleep quality and diet quality, respectively. Glycated hemoglobin (HbA1c) and FGM-reported glycemia components among children with T1D were assessed as well.

Results: Of the 47 participants surveyed (25 boys, 22 girls, 9.31 ± 2.88 years), the majority reported high HbA1c, good sleep quality, and high adherence to the MD. However, only one-third of the participants reported a healthy sleep duration. Only the sleep latency was significantly (P < 0.05) associated with the time above range level 2 and time below range level 2 (P = 0.048) components of the FGM. A positive correlation (r = 0.309, P = 0.035) was reported between adherence to MD and time in range of the FGM.

Conclusions: Diet quality and sleep quality are variably inter-correlated with FGM-measured glycemia among young patients with T1D and are suggested to be considered influential factors in FGM-monitored diabetes research on this age group.

Keywords: Diabetes mellitus; Mediterranean diet; glycemic control; healthy lifestyle; sleep quality.

Figure 1

FGM glucose profile (n=36) in 14 days. The red line indicates median glucose and the purple shaded area shows the 25^th and 75^th percentiles. Black dotted lines denote the 5^th and 95^th percentiles

Figure 2

Percentage of time in ranges in 14 days. TIR = Percentage of time in range (70-180 mg/dL, 3.9-10.0 mmol/L), TBR (Level 1) = percentage of time below range (TBR) level 1 (<70-54 mg/dL, <3.9-3.0 mmol/L), TBR (Level 2) = percentage of time below range (TBR) level 2 (<54 mg/dL, <3.0 mmol/L), TAR (Level 1) = percentage of time above range (TAR) level 1 (>180-250 mg/dL, >10.0 mmol/L), TAR (Level 2) = percentage of time above range (TAR) level 2 (>250 mg/dL, >13.9 mmol/L)