Impact of the Hybrid Closed-Loop System on Sleep and Quality of Life in Youth with Type 1 Diabetes and Their Parents

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 ∼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.