Sleep Promotion to Improve Diabetes Management in Adolescents with T1D

摘要 患有1型糖尿病(T1D)的青少年出现依从性和次优问题的风险增加 需要血糖控制和新的方法来改善这一高危人群的结果。这个 大多数青少年睡眠不足(定义为每晚8小时)，在我们的数据中，睡眠障碍 与较差的遵从性显著相关，并预示着生活质量和 血糖控制更差。然而，还没有干预措施解决患有T1D的青少年的睡眠问题。从一个 睡眠的生物-心理-社会和情境模型，我们建议量身定做一种促进睡眠的干预措施，以满足 通过与T1D青少年进行访谈，确定障碍和促进者，以充分满足T1D青少年的需求 睡眠是这一群体特有的。然后，我们将开发并试行一种简短的、行为促进睡眠的方法 干预，建立在其他人群成功干预的基础上，包括限制 咖啡因，建立媒体宵禁，以及积极的就寝时间，同时满足 青少年患有T1D等恐低血糖。这项研究将由一个多学科团队进行， 由Sarah Jaser博士，儿科心理学家，Beth Malow，医学博士，医学硕士，神经学家组成，专门从事 睡眠医学，Cindy Lybarger，MSN，APRN，CDE，护士从业者和糖尿病认证教育者，以及 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，它可能既有 生理和行为对糖尿病结局的影响。鉴于睡眠和睡眠之间的紧密联系 在我们的初步数据中，糖尿病的预后，以及不断积累的证据表明影响不足 睡眠对胰岛素的敏感性、行为和情绪，有理由相信是一种促进睡眠的干预措施 有可能通过改善自我管理和间接改善患有T1D的青少年的预后 直接通过其对代谢功能和血糖控制的影响。因此，拟议的研究提供了一个 改善T1D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.