Novel insights in understanding the relation of glycemic excursions and concomitant sleep macro- and micro-architecture among adolescents with type 1 diabetes

Marianna Rachmiel; Dana Blatch; Avital Leshem; Caroline Weill; Mordechay Medvedovsky; Mirit Lezinger; Eli Heyman; Dana Ekstein

doi:10.1530/endoabs.110.OC2.3

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Endocrine Abstracts (2025) 110 OC2.3 | DOI: 10.1530/endoabs.110.OC2.3

ECEESPE2025 Oral Communications Oral Communications 2: Diabetes and Insulin Part 1 (6 abstracts)

Novel insights in understanding the relation of glycemic excursions and concomitant sleep macro- and micro-architecture among adolescents with type 1 diabetes

Marianna Rachmiel ^1,2 , Dana Blatch ³ , Avital Leshem ¹ , Caroline Weill ^3,4 , Mordechay Medvedovsky ^3,4 , Mirit Lezinger ⁵ , Eli Heyman ⁵ & Dana Ekstein ^3,4

Author affiliations

¹Pediatric Diabetes and Endocrinology Institute, Shamir (Assaf Haroffeh) Medical Center, Beer Yaakov, Israel; ²School of Medicine, Tel Aviv University, Tel Aviv, Israel; ³Hadassah Medical Center,, Department of Neurology, the Agnes Ginges Center for Human Neurogenetics, Jerusalem, Israel; ⁴Faculty of Medicine, the Hebrew University of Jerusalem, Jerusalem, Israel; ⁵Department of Pediatric Neurology, Shamir (Assaf Haroffeh) Medical Center, Beer Yaakov, Israel

JOINT3725

Background and objective: The bidirectional influence between glycemic variability and quality of sleep among patients with type 1 Diabetes (T1D) has not been fully elucidated yet. We aimed to characterize real-time interactions of sleep parameters, including electrical activity, with immediate glycemic excursions, among adolescents with T1D, compared to their healthy siblings.

Methods: Twenty-two patients with T1D, 50% males, median age 14.6 years (13.7,15.8), and 13 of their healthy siblings, 61.5% males, median age 14.8 years (13.2,16), were included in the study. They were divided to well-controlled (WC-T1D) and poorly controlled (PC-T1D), according to HbA1c cutoff 8.3%. All were monitored continuously and simultaneously with an actigraph, electroencephalogram (EEG) and continuous glucose monitoring system (CGMS) for interstitial glucose concentrations (IGC), for one night. EEG recordings were used to calculate EEG power at frequency bands from delta to high gamma, averaged over different brain regions. IGC was divided to near-normal glucose range of 61-180 mg/dl, and high glucose of >180 mg/dl.

Results: During awakening (WASO), the percentage of time spent in optimal range was significantly higher in the Healthy group compared with the T1D group, (100% vs. 45.4%, P=0.001), mainly the WC-T1D subgroup, in which longer time was spent at the higher glucose levels during WASO. Higher percentage of time spent in 61-180 mg/dl range, was associated with longer NREM3 r=0.51, P=0.012, but with a shorter TST r=-0.49, P=0.03, in the T1D group. A similar trend with negative correlation between percent of time spent in 61-180 mg/dl and TST was seen in the Healthy group, r=-0.51, P=0.07. Lower EEG power was demonstrated in T1D group compared with the Healthy group, mainly at frequency bands delta, theta and beta during NREM stage 1, and bands delta, beta and gamma during WASO. Significantly lower EEG power was detected during N1, REM and WASO when IGC was >180 mg/dl in the T1D group, compared with the Healthy group, at most frequency bands and brain regions. Those differences were not detected with near normal IGC. In contrast, higher HbA1c was associated with lower EEG power during all sleep stages and across most frequency bands and brain regions.

Conclusions: EEG power in various sleep stages is differently regulated by chronic glycemic control and by acute glucose excursions, explained physiologically according to reflective cortisol secretion and modulation of autonomous nervous system. Effective management goals among the pediatric population with T1D, should include both lower HbA1c and longer time spent with IGC<180 mg/dl.