Sleep Promotion to Improve Diabetes Management in Adolescents with T1D

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Summary Adolescents with type 1 diabetes (T1D) are at increased risk for problems with adherence and suboptimal glycemic control, and novel approaches are needed to improve outcomes in this high-risk population. The majority of adolescents obtain insufficient sleep (defined as <8 hours/night), and in our data, sleep disturbance was significantly associated with poorer adherence and predicted greater problems with quality of life and worse glycemic control. Yet, no interventions have addressed sleep in youth with T1D. Working from a biopsychosocial and contextual model of sleep, we propose to tailor a sleep-promoting intervention to meet the needs of adolescents with T1D by conducting interviews with to identify the barriers and facilitators to adequate sleep specific to this population. We will then develop and pilot test a brief, behavioral sleep-promoting intervention, building on successful interventions in other populations, including components such as limiting caffeine, establishing a media curfew, and positive bedtime routines, while addressing the needs unique to adolescents with T1D, such as fear of hypoglycemia. The study will be conducted by a multidisciplinary team, consisting of Sarah Jaser, PhD, a pediatric psychologist, Beth Malow, MD, MS, a neurologist with specialty in sleep medicine, Cindy Lybarger, MSN, APRN, CDE, a nurse practitioner and certified diabetes educator, and Jill Simmons, MD, a pediatric endocrinologist. Sleep is a potentially modifiable risk factor that may have both a physiological and behavioral impact on diabetes outcomes. Given the strong associations between sleep and diabetes outcomes in our preliminary data, and accumulating evidence indicating the impact of insufficient sleep on insulin sensitivity, behavior, and mood, there is reason to believe that a sleep-promoting intervention has the potential to improve outcomes in adolescents with T1D indirectly by improving self-management and directly through its effect on metabolic function and glycemic control. Therefore, the proposed study offers a novel approach to improve glycemic control, adherence, and quality of life in adolescents with T1D.