Impact of the Hybrid Closed-Loop System on Sleep and Quality of Life in Youth with Type 1 Diabetes and Their Parents
Impact of the Hybrid Closed-Loop System on Sleep and Quality of Life in Youth with Type 1 Diabetes and Their Parents
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DOI：
10.1089/dia.2020.0057
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发表时间：
2020-10-13
影响因子：
5.4
通讯作者：
Jaser, Sarah S.
中科院分区：
文献类型：
--
作者：
Cobry, Erin C.;Hamburger, Emily;Jaser, Sarah S.
背景：睡眠不足在1型糖尿病（T1 D）青少年和父母中很常见，可能继发于糖尿病相关障碍，包括对低血糖的恐惧、夜间血糖监测、低血糖和器械警报。混合闭环（HCL）系统改善血糖变异性，并可能减少夜间觉醒。方法：T1 D青少年（N = 37，平均年龄13.9岁，62%为女性，平均HbA 1c 8.3%）及其父母在开始使用Medtronic 670 G HCL系统时入组本观察性研究。参与者在开始自动模式之前完成了研究测量（睡眠和心理社会调查以及带有睡眠日记的活动记录仪），与3个月后相似。结果：根据体动记录数据，青少年和父母的睡眠特征在使用设备前后都没有显著变化。青少年的平均总睡眠时间从7小时16分钟（IQR：[6：43-7：47]）减少到7小时9分钟（IQR：[6：44-7：52]），而父母的总睡眠时间从6小时47分钟（IQR：[6：16-7：10]）减少到6小时38分钟（IQR：[5：57-6：57]）。虽然在大多数调查指标中没有显著差异，但对改善父母的睡眠质量和青少年对低血糖的恐惧有中度影响。此外，青少年报告自我报告的血糖监测满意度显着增加。3个月时，青少年平均使用自动模式的比例为44.7%。结论：我们的数据支持先前的研究，表明患有T1 D的青少年及其父母没有达到推荐的睡眠时间。睡眠缺乏改善可能是由于与新技术有关的陡峭的学习曲线。我们观察到适度改善父母的主观报告的睡眠质量，尽管没有改变客观措施的睡眠时间。需要进一步评估长期使用HCL和更大样本量的睡眠。
Background:Insufficient sleep is common in youth with type 1 diabetes (T1D) and parents, likely secondary to diabetes-related disturbances, including fear of hypoglycemia, nocturnal glucose monitoring, hypoglycemia, and device alarms. Hybrid closed-loop (HCL) systems improve glycemic variability and potentially reduce nocturnal awakenings. Methods:Adolescents with T1D (N = 37, mean age 13.9 years, 62% female, mean HbA1c 8.3%) and their parents were enrolled in this observational study when starting the Medtronic 670G HCL system. Participants completed study measures (sleep and psychosocial surveys and actigraphy with sleep diaries) before starting auto mode and similar to 3 months later. Results:Based on actigraphy data, neither adolescents' nor parents' sleep characteristics changed significantly pre-post device initiation. Adolescents' mean total sleep time decreased from 7 h 16 min (IQR: [6:43-7:47]) to 7 h 9 min (IQR: [6:44-7:52]), while parents' total sleep time decreased from 6 h 47 min (IQR: [6:16-7:10]) to 6 h 38 min (IQR: [5:57-6:57]). Although there were no significant differences in most of the survey measures, there was a moderate effect for improved sleep quality in parents and fear of hypoglycemia in adolescents. In addition, adolescents reported a significant increase in self-reported glucose monitoring satisfaction. Adolescents averaged 44.7% use of auto mode at 3 months. Conclusions:Our data support previous research showing youth with T1D and their parents are not achieving the recommended duration of sleep. Lack of improvement in sleep may be due to steep learning curves involved with new technology. We observed moderate improvements in parental subjective report of sleep quality despite no change in objective measures of sleep duration. Further evaluation of sleep with long-term HCL use and larger sample size is needed.