Could better sleep be the answer for improving glycemic control in type 2 diabetes mellitus patients?

A new study in the Journal of Clinical & Translational Endocrinology suggested that might be the case. The article pointed out that acute and chronic insomnia can exacerbate T2DM.

Earlier research indicated a link between poor sleep and developing diabetes. The question explored by Japanese researchers is whether treating sleep disorders could improve glycemic control. They investigated the effect of suvorexant, an anti-insomnia drug that targets the orexin system, on sleep architecture and glucose metabolism in diabetes patients with insomnia.

Hand holding white pills

The FDA approved suvorexant, marketed as Belsomra, in 2014 for the treatment of insomnia characterized by difficulties with sleep onset and/or sleep maintenance. 

The study from Osaka City University Graduate School of Medicine was a 7 day open-label, single-arm, intervention trial that included 18 subjects with T2DM and insomnia. After allowing patients a 1 day acclimatization, researchers tracked daily glucose levels, sleep architecture, and autonomic nervous function using continuous glucose monitoring (CGM), single-channel electroencephalography, and accelerometry, respectively.

Results indicated that suvorexant treatment for 3 days significantly increased total sleep time and sleep efficiency, with partial suppression of sympathetic nerve activity. In fact, CGM-measured 24 hour mean glucose level decreased significantly from 157.7 ± 22.9 to 152.3 ± 17.8 mg/dL That was especially the case in the early glucose surge after the midnight nadir – a decline from 28.3 ± 15.0 to 18.2 ± 9.9 mg/dL --  and until supper with a significant improvement in homeostasis model assessment of insulin resistance from 4.0 ± 2.8 to 2.9 ± 1.6.

“Suvorexant treatment for insomnia of subjects with T2DM significantly improved CGM-measured daily glycemic control, which was associated with changes in sympathomimetic tone and/or improved insulin sensitivity,” study authors wrote. “The amelioration of insomnia may therefore be a target for improving glycemic control in T2DM patients with insomnia.”

The relationship between sleep and diabetes is a complex one, with a study last year finding that insomnia is associated with an increased risk of developing T2DM.

Kaiser Permanente researchers conducted a retrospective cohort study to examine the risk of developing T2DM among patients with pre-diabetes with and without insomnia.

The study published in BMJ Open Diabetes Research & Care including 81,233 participants with pre-diabetes, 29.7% of whom had insomnia at some point during the 4.3-year average observation period.

Researchers determined that patients with insomnia were 28% more likely to develop T2DM than those without insomnia (HR 1.28; 95% CI 1.24 to 1.33). The estimate was essentially unchanged after adjusting for baseline A1c level (HR 1.32; 95% CI 1.25 to 1.40) or FPG (HR 1.28; 95% CI 1.23 to 1.33).

“Insomnia imparts an increased risk of T2DM comparable with that conferred by traditional risk factors (eg, overweight, non-white race, cardiovascular risk factors),” study authors wrote. “This association could have clinical importance because it suggests a new potentially modifiable risk factor that could be targeted to prevent diabetes.”