Personalizing Sleep Interventions to Prevent Type 2 Diabetes in Community Dwelling Adults with Pre-Diabetes

项目总结 饮食和运动干预在预防和延迟T2D发病方面取得了很大进展：好处是 在某些人身上胜过药理学干预。然而，来自不那么强烈的、更多的 负担得起的干预措施和随着时间的推移收益逐渐减少是重大限制。确定其他 需要能够扩大干预选择的可修改因素，而不仅仅是饮食和锻炼，以达到 迄今为止，抗药性群体和维持新陈代谢的好处。一个可行的选择是改善睡眠。多重 睡眠维度与人的T2D风险和血糖控制不良独立相关 使用T2D。据报道，在一个以每日延长睡眠为基础的小型社区中，胰岛素敏感性有所改善 研究(N=16)，以及一项为期两天的基于实验室的睡眠延长研究，使用的是个性化的“追赶”睡眠 对健康成人(N=19)进行干预。受限于小样本量、受控的实验室条件以及 排除T2D风险最高的人，睡眠在减轻T2D风险中的作用仍不确定。一个 对于定制睡眠干预来说，重要但尚未回答的问题是，规律的睡眠时间是否应该 按优先顺序排列。鉴于不规则的睡眠-觉醒时间普遍存在，确定新陈代谢的好处或 这种睡眠习惯的负担是至关重要的。在这个K99/R00奖项中提出的项目是迈向 在将昼夜节律和新陈代谢与时间治疗联系起来的研究计划中的独立性 降低2型糖尿病(T2D)风险的干预措施。 研究：在K99阶段提出的研究将利用现有的数据集来量化 糖尿病患者、糖尿病前期患者和正常血糖患者的不规则睡眠时间对血糖调节的影响。这 将阐明个体对不规律睡眠时间的适应能力或脆弱性的差异。主要 结果指标将是血红蛋白A1c(糖尿病和糖尿病前期患者)或胰岛素抵抗。 (适用于血糖正常的人)。在R00阶段提出的研究将测试每天一次 睡眠延长干预与习惯性睡眠模式对血糖为140 mg/dL的时间百分比的影响 (每组75例)睡眠受限的社区糖尿病前期成年人。可穿戴传感器 将使用技术(连续血糖监测和加速度计)。这项研究将告诉人们- 改善血糖反应的特定睡眠干预措施，从而为糖尿病前期状态提供治疗。 培训：为了实现总体职业目标，培训计划将建立在候选人的 通过在设计睡眠干预、可穿戴传感器技术方面为她提供深入的培训 (特别是连续血糖监测)，以及对大量实时数据的分析。这次培训 还将包括提高她在写作和展示科学发现方面的技能，以及 成为科学界的领导者。将使用各种方法来实现这些目标 包括正式的课程作业和结构化的一对一指导。

PROJECT SUMMARY Diet and exercise interventions have made great strides in preventing and delaying T2D onset: benefits that surpass pharmacological interventions in some persons. Yet, variable responses from less intense, more affordable interventions and waning benefits over time are significant limitations. Identifying additional modifiable factors that can expand intervention options, beyond diet and exercise, are needed to reach heretofore resistant groups and to sustain metabolic benefits. One viable option is improving sleep. Multiple dimensions of sleep have been independently associated with T2D risk and poor glucose control in persons with T2D. Improved insulin sensitivity has been reported in a small community based daily sleep extension study (N= 16), as well as in a 2-day lab based sleep extension study using a personalized “catch up” sleep intervention in healthy adults (N = 19,). Limited by small sample sizes, controlled lab conditions, and the exclusion of persons at greatest risk for T2D, the role of sleep in mitigating T2D risk remains uncertain. An important but unanswered question for tailoring sleep interventions is whether regular sleep timing should be prioritized. Given that irregular sleep-wake timing is widely prevalent, identifying the metabolic benefits or burdens of this sleep habit is critical. The proposed project in this K99/R00 award is a step toward independence in a program of research bridging circadian rhythms and metabolism to chrono-therapeutic interventions that mitigate type 2 diabetes (T2D) risk. Research: The study proposed in the K99 phase will leverage an existing data set to quantify the effects of irregular sleep timing on glucose regulation in persons with diabetes, prediabetes, and normoglycemia. This will elucidate individual differences in resiliency against or vulnerability to irregular sleep timing. Primary outcome measures will be hemoglobin A1c (for persons with diabetes and prediabetes) or insulin resistance (for persons with normoglycemia). The study proposed during the R00 phase will test the effects of a daily sleep extension intervention versus habitual sleep patterns on the percentage of time glucose is  140 mg/dL (n = 75 per group) in sleep restricted community-dwelling adults with pre-diabetes. Wearable sensor technologies (continuous glucose monitoring and accelerometry) will be used. This study will inform person- specific sleep interventions that improve glycemic responses, thus providing treatment for the prediabetic state. Training: To achieve overall career goals, the training plan will build upon the candidate's background in diabetes by affording her in-depth training in designing sleep interventions, wearable sensor technologies (specifically continuous glucose monitoring), and the analysis of large amounts of real time data. This training will also incorporate advancing her skills in writing and presenting scientific findings, as well as the skills to become a leader in the scientific community. A variety of approaches will be used to achieve these goals including formal coursework and structured one-on-one mentorship.