Key result
Short or long sleep linked to ~71% higher microvascular risk in T2DM.
Why the study?
Data on the longitudinal effects of abnormal sleep duration on microvascular outcomes in type 2 diabetes mellitus, particularly in Asian populations, remain limited.
Does abnormal sleep duration increase the risk of microvascular complications in adults with type 2 diabetes?
Cohort (n=1,236)
Does abnormal sleep duration increase the risk of microvascular complications in adults with type 2 diabetes?
Hazard Ratio: 1.71 (95% CI 1.1–2.66)
p-value: p=0.018
Both insufficient (<7h) and excessive (≥10h) sleep durations are associated with an increased risk of microvascular complications in patients with type 2 diabetes, suggesting 7-8 hours of sleep is optimal.
May warrant sleep assessment in T2DM; hypothesis-generating for trials on sleep modification to reduce microvascular complications.
Introduction and Objective: Abnormal sleep duration is a modifiable lifestyle factor, but its longitudinal effects on microvascular outcomes in type 2 diabetes mellitus (T2DM), especially from Asian populations, remains limited. This study aimed to investigate the prospective association between habitual sleep duration and the incidence of microvascular complications in T2DM patients. Methods: This prospective cohort study included 1,236 adults with T2DM free of microvascular complications at baseline from the National Metabolic Management Centre Ningbo Branch (2018 - 2023). Sleep duration was self-reported and categorized as <7, 7 to <8, 8 to <9, 9 to <10, or ≥10h/day. Incident microvascular complications included diabetic kidney disease (DKD), retinopathy (DR), and peripheral neuropathy (DPN) was ascertained during follow-up. Cox regression models and restricted cubic spline analysis were used to estimate hazard ratio (HRs) and assess dose-response relationships. Results: Over 2,459 person-years of follow-up, 237 participants developed microvascular complications. A U-shaped association was observed between sleep duration and composite microvascular complications (P for nonlinearity=0.001) and DPN (P for nonlinearity=0.038), with the lowest risk at 7-8 h/day. Compared to 7 to <8h, both shorter (< 7h) and longer (≥10h) durations were associated with increased risks of composite microvascular complications (HR=1.71, 95% CI [1.10-2.66], P=0.018; HR=1.87, 95% CI [1.20-2.92], P=0.005, respectively). Associations were more pronounced among older individuals, those with higher BMI, or prolonged sedentary behavior. Conclusion: Both insufficient and excessive sleep durations are associated with increased risks of microvascular complications in T2DM. Maintaining 7-8 hours of sleep daily may represent a simple yet important behavioral target in the comprehensive management of T2DM, potentially reducing the burden of microvascular complications. Disclosure M. Xu: None. Y. Zhou: None. J. Li: None. L. Li: None. Y. Wang: None. Funding Noncommunicable Chronic Diseases-National Science and Technology Major Project (2023ZD0508100), Ningbo medical and health brand discipline (PPXK2024-03), Major Project of Scientific and Technological Innovation 2035 of Ningbo Science and Technology Bureau (2024Z234), the Medical Health Science and Technology Project of Zhejiang Province (2024KY1521), the Program of China Scholarship Council (CSC No. 202406010169)
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XU et al. (2026) conducted a cohort in Type 2 diabetes mellitus (n=1,236). Abnormal sleep duration (<7h or ≥10h/day) vs. 7 to <8h/day sleep duration was evaluated on Composite microvascular complications (diabetic kidney disease, retinopathy, and peripheral neuropathy) (HR 1.71, 95% CI 1.10-2.66, p=0.018). Compared to 7-8 hours, sleep durations <7 hours (HR 1.71; 95% CI 1.10-2.66) and ≥10 hours (HR 1.87; 95% CI 1.20-2.92) were associated with increased risks of microvascular complications in T2DM.
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