Endocrine Abstracts

Introduction: Hybrid closed-loop (HCL) systems have been shown to improve glycaemic control and treatment satisfaction in children and young people with Type 1 Diabetes Mellitus (T1DM), including increased time-in-range and reduced hypoglycaemic events. While HCL may reduce nocturnal glycaemic variability and improve sleep, few have explored this relationship qualitatively to understand its real-life impact. We evaluated the impact of HCL systems on sleep in paediatric patients with T1DM at Imperial College Healthcare Trust (ICHT).

Methods: In May 2024, a qualitative survey was conducted over a three-week period at ICHT paediatric diabetes annual review clinics. Participation was voluntary and based on convenience sampling during routine clinic visits. Eligible participants included children aged 18 or under with a HCL system, and parents/guardians of children in this group. The survey included open- and closed-ended questions, exploring sleep and factors affecting sleep quality.

Results: Sixteen responses were collected as part of a small, exploratory quality improvement project and conducted across two diabetes clinics - one paediatric and one adolescent - at ICHT. Participants included 9 parents/guardians and 7 children aged 4 to 18 years, with 2 children choosing not to participate. On a scale from 1 (“Very Bad”) to 5 (“Very Good”), children rated their average sleep quality at 2.96, while parents rated theirs lower at 2.30. Both groups reported frequent sleep disturbances. Among children, disrupted sleep was commonly attributed to symptoms of hyperglycaemia or hypoglycaemia, restlessness, and urinary urgency. Parents most frequently cited anxiety and the demands of night-time caregiving. Seven parents described how disturbed sleep affected their child’s functioning the following day. They reported consequences such as grogginess, migraines, low energy, and difficulty waking in the morning. While all parents reported consistent night-time routines involving blood glucose checks, five of the seven children reported no structured bedtime routine.

Discussion: Despite advances in closed-loop insulin delivery, sleep disturbance remains a significant challenge for children with T1DM and their families. Sleep quality should be specifically explored at clinic review. A larger study is needed to gain further understanding of the factors contributing to sleep disturbance, so that strategies can be developed to improve sleep.