Sleep Promotion to Improve Diabetes Management in Adolescents with T1D

总结 青少年1型糖尿病（T1 D）患者出现依从性和次优问题的风险增加 血糖控制，需要新的方法来改善这一高危人群的结局。的 大多数青少年睡眠不足（定义为<8小时/晚），在我们的数据中，睡眠障碍 与较差的依从性显著相关，并预测生活质量存在更大的问题， 血糖控制更差然而，没有干预措施解决了T1 D青年的睡眠问题。从一个 睡眠的生物心理社会和上下文模型，我们建议量身定制一个睡眠促进干预，以满足 通过与T1 D青少年进行访谈，以确定适当的障碍和促进因素， 睡眠是这个人群特有的。然后，我们将开发和试点测试一个简短的，行为睡眠促进 在其他人群成功干预措施的基础上， 咖啡因，建立媒体宵禁，以及积极的就寝时间，同时解决 青少年T1 D，如低血糖的恐惧。这项研究将由一个多学科小组进行， 包括Sarah Jaser博士，儿科心理学家，Beth Malow博士，MS，神经学家， 睡眠医学，辛迪Lybarger，MSN，APRN，CDE，护士执业和认证的糖尿病教育家，和 吉尔·西蒙斯医学博士儿科内分泌学家睡眠是一个潜在的可改变的风险因素， 生理和行为对糖尿病结果的影响。考虑到睡眠和 糖尿病的结果在我们的初步数据，并积累证据表明，影响不足， 睡眠对胰岛素敏感性、行为和情绪有影响，有理由相信，促进睡眠的干预措施 有可能通过改善自我管理间接改善T1 D青少年的结局， 直接通过其对代谢功能和血糖控制的影响。因此，这项研究提供了一个 改善T1 D青少年血糖控制、依从性和生活质量的新方法。

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.