A Comparison of the Rates of Clock-Based Nocturnal Hypoglycemia and Hypoglycemia While Asleep Among People Living with Diabetes: Findings from the Hypo-METRICS Study

Hypo-RESOLVE Consortium; Gilberte Martine-Edith; Patrick Divilly; Natalie Zaremba; Uffe Søholm; Melanie Broadley; Petra Martina Baumann; Zeinab Mahmoudi; Mikel Gomes; Namam Ali; Evertine J. Abbink; Bastiaan de Galan; Julie Brøsen; Ulrik Pedersen-Bjergaard; Allan A. Vaag; Rory J. McCrimmon; Eric Renard; Simon Heller; Mark Evans; Monika Cigler; Julia K. Mader; Jane Speight; Frans Pouwer; Stephanie A. Amiel; Pratik Choudhary

doi:10.1089/dia.2023.0522

A Comparison of the Rates of Clock-Based Nocturnal Hypoglycemia and Hypoglycemia While Asleep Among People Living with Diabetes: Findings from the Hypo-METRICS Study

Hypo-RESOLVE Consortium, Gilberte Martine-Edith^*, Patrick Divilly, Natalie Zaremba, Uffe Søholm, Melanie Broadley, Petra Martina Baumann, Zeinab Mahmoudi, Mikel Gomes, Namam Ali, Evertine J. Abbink, Bastiaan de Galan, Julie Brøsen, Ulrik Pedersen-Bjergaard, Allan A. Vaag, Rory J. McCrimmon, Eric Renard, Simon Heller, Mark Evans, Monika CiglerJulia K. Mader, Jane Speight, Frans Pouwer, Stephanie A. Amiel, Pratik Choudhary

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

5 Citations (Scopus)

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Abstract

Introduction: Nocturnal hypoglycemia is generally calculated between 00:00 and 06:00. However, those hours may not accurately reflect sleeping patterns and it is unknown whether this leads to bias. We therefore compared hypoglycemia rates while asleep with those of clock-based nocturnal hypoglycemia in adults with type 1 diabetes (T1D) or insulin-treated type 2 diabetes (T2D). Methods: Participants from the Hypo-METRICS study wore a blinded continuous glucose monitor and a Fitbit Charge 4 activity monitor for 10 weeks. They recorded details of episodes of hypoglycemia using a smartphone app. Sensor-detected hypoglycemia (SDH) and person-reported hypoglycemia (PRH) were categorized as nocturnal (00:00–06:00 h) versus diurnal and while asleep versus awake defined by Fitbit sleeping intervals. Paired-sample Wilcoxon tests were used to examine the differences in hypoglycemia rates. Results: A total of 574 participants [47% T1D, 45% women, 89% white, median (interquartile range) age 56 (45–66) years, and hemoglobin A1c 7.3% (6.8–8.0)] were included. Median sleep duration was 6.1 h (5.2–6.8), bedtime and waking time *23:30 and 07:30, respectively. There were higher median weekly rates of SDH and PRH while asleep than clock-based nocturnal SDH and PRH among people with T1D, especially for SDH <70 mg/dL (1.7 vs. 1.4, P < 0.001). Higher weekly rates of SDH while asleep than nocturnal SDH were found among people with T2D, especially for SDH <70 mg/dL (0.8 vs. 0.7, P < 0.001). Conclusion: Using 00:00 to 06:00 as a proxy for sleeping hours may underestimate hypoglycemia while asleep. Future hypoglycemia research should consider the use of sleep trackers to record sleep and reflect hypoglycemia while asleep more accurately.

Original language	English
Pages (from-to)	433-441
Number of pages	9
Journal	Diabetes Technology and Therapeutics
Volume	26
Issue number	7
Early online date	12 Jul 2024
DOIs	https://doi.org/10.1089/dia.2023.0522
Publication status	Published - Jul 2024

Keywords

Continuous glucose monitoring
Fitbit
Hypo-METRICS
Nocturnal hypoglycemia
Sleep tracking

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1089/dia.2023.0522

Martine-Edith et al., Clock based nocturnal vs asleep hypoglycemiaAccepted author manuscript, 886 KB

Cite this

Hypo-RESOLVE Consortium, Martine-Edith, G., Divilly, P., Zaremba, N., Søholm, U., Broadley, M., Baumann, P. M., Mahmoudi, Z., Gomes, M., Ali, N., Abbink, E. J., de Galan, B., Brøsen, J., Pedersen-Bjergaard, U., Vaag, A. A., McCrimmon, R. J., Renard, E., Heller, S., Evans, M., ... Choudhary, P. (2024). A Comparison of the Rates of Clock-Based Nocturnal Hypoglycemia and Hypoglycemia While Asleep Among People Living with Diabetes: Findings from the Hypo-METRICS Study. Diabetes Technology and Therapeutics, 26(7), 433-441. https://doi.org/10.1089/dia.2023.0522

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title = "A Comparison of the Rates of Clock-Based Nocturnal Hypoglycemia and Hypoglycemia While Asleep Among People Living with Diabetes: Findings from the Hypo-METRICS Study",

abstract = "Introduction: Nocturnal hypoglycemia is generally calculated between 00:00 and 06:00. However, those hours may not accurately reflect sleeping patterns and it is unknown whether this leads to bias. We therefore compared hypoglycemia rates while asleep with those of clock-based nocturnal hypoglycemia in adults with type 1 diabetes (T1D) or insulin-treated type 2 diabetes (T2D). Methods: Participants from the Hypo-METRICS study wore a blinded continuous glucose monitor and a Fitbit Charge 4 activity monitor for 10 weeks. They recorded details of episodes of hypoglycemia using a smartphone app. Sensor-detected hypoglycemia (SDH) and person-reported hypoglycemia (PRH) were categorized as nocturnal (00:00–06:00 h) versus diurnal and while asleep versus awake defined by Fitbit sleeping intervals. Paired-sample Wilcoxon tests were used to examine the differences in hypoglycemia rates. Results: A total of 574 participants [47% T1D, 45% women, 89% white, median (interquartile range) age 56 (45–66) years, and hemoglobin A1c 7.3% (6.8–8.0)] were included. Median sleep duration was 6.1 h (5.2–6.8), bedtime and waking time *23:30 and 07:30, respectively. There were higher median weekly rates of SDH and PRH while asleep than clock-based nocturnal SDH and PRH among people with T1D, especially for SDH <70 mg/dL (1.7 vs. 1.4, P < 0.001). Higher weekly rates of SDH while asleep than nocturnal SDH were found among people with T2D, especially for SDH <70 mg/dL (0.8 vs. 0.7, P < 0.001). Conclusion: Using 00:00 to 06:00 as a proxy for sleeping hours may underestimate hypoglycemia while asleep. Future hypoglycemia research should consider the use of sleep trackers to record sleep and reflect hypoglycemia while asleep more accurately.",

keywords = "Continuous glucose monitoring, Fitbit, Hypo-METRICS, Nocturnal hypoglycemia, Sleep tracking",

author = "{Hypo-RESOLVE Consortium} and Gilberte Martine-Edith and Patrick Divilly and Natalie Zaremba and Uffe S{\o}holm and Melanie Broadley and Baumann, {Petra Martina} and Zeinab Mahmoudi and Mikel Gomes and Namam Ali and Abbink, {Evertine J.} and {de Galan}, Bastiaan and Julie Br{\o}sen and Ulrik Pedersen-Bjergaard and Vaag, {Allan A.} and McCrimmon, {Rory J.} and Eric Renard and Simon Heller and Mark Evans and Monika Cigler and Mader, {Julia K.} and Jane Speight and Frans Pouwer and Amiel, {Stephanie A.} and Pratik Choudhary",

year = "2024",

month = jul,

doi = "10.1089/dia.2023.0522",

language = "English",

volume = "26",

pages = "433--441",

journal = "Diabetes Technology and Therapeutics",

issn = "1520-9156",

publisher = "Mary Ann Liebert",

number = "7",

}

Hypo-RESOLVE Consortium, Martine-Edith, G, Divilly, P , Zaremba, N, Søholm, U, Broadley, M, Baumann, PM, Mahmoudi, Z, Gomes, M, Ali, N, Abbink, EJ, de Galan, B, Brøsen, J, Pedersen-Bjergaard, U, Vaag, AA, McCrimmon, RJ, Renard, E, Heller, S, Evans, M, Cigler, M, Mader, JK, Speight, J, Pouwer, F, Amiel, SA & Choudhary, P 2024, 'A Comparison of the Rates of Clock-Based Nocturnal Hypoglycemia and Hypoglycemia While Asleep Among People Living with Diabetes: Findings from the Hypo-METRICS Study', Diabetes Technology and Therapeutics, vol. 26, no. 7, pp. 433-441. https://doi.org/10.1089/dia.2023.0522

A Comparison of the Rates of Clock-Based Nocturnal Hypoglycemia and Hypoglycemia While Asleep Among People Living with Diabetes: Findings from the Hypo-METRICS Study. / Hypo-RESOLVE Consortium; Martine-Edith, Gilberte; Divilly, Patrick et al.
In: Diabetes Technology and Therapeutics, Vol. 26, No. 7, 07.2024, p. 433-441.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - A Comparison of the Rates of Clock-Based Nocturnal Hypoglycemia and Hypoglycemia While Asleep Among People Living with Diabetes

T2 - Findings from the Hypo-METRICS Study

AU - Hypo-RESOLVE Consortium

AU - Martine-Edith, Gilberte

AU - Divilly, Patrick

AU - Zaremba, Natalie

AU - Søholm, Uffe

AU - Broadley, Melanie

AU - Baumann, Petra Martina

AU - Mahmoudi, Zeinab

AU - Gomes, Mikel

AU - Ali, Namam

AU - Abbink, Evertine J.

AU - de Galan, Bastiaan

AU - Brøsen, Julie

AU - Pedersen-Bjergaard, Ulrik

AU - Vaag, Allan A.

AU - McCrimmon, Rory J.

AU - Renard, Eric

AU - Heller, Simon

AU - Evans, Mark

AU - Cigler, Monika

AU - Mader, Julia K.

AU - Speight, Jane

AU - Pouwer, Frans

AU - Amiel, Stephanie A.

AU - Choudhary, Pratik

PY - 2024/7

Y1 - 2024/7

N2 - Introduction: Nocturnal hypoglycemia is generally calculated between 00:00 and 06:00. However, those hours may not accurately reflect sleeping patterns and it is unknown whether this leads to bias. We therefore compared hypoglycemia rates while asleep with those of clock-based nocturnal hypoglycemia in adults with type 1 diabetes (T1D) or insulin-treated type 2 diabetes (T2D). Methods: Participants from the Hypo-METRICS study wore a blinded continuous glucose monitor and a Fitbit Charge 4 activity monitor for 10 weeks. They recorded details of episodes of hypoglycemia using a smartphone app. Sensor-detected hypoglycemia (SDH) and person-reported hypoglycemia (PRH) were categorized as nocturnal (00:00–06:00 h) versus diurnal and while asleep versus awake defined by Fitbit sleeping intervals. Paired-sample Wilcoxon tests were used to examine the differences in hypoglycemia rates. Results: A total of 574 participants [47% T1D, 45% women, 89% white, median (interquartile range) age 56 (45–66) years, and hemoglobin A1c 7.3% (6.8–8.0)] were included. Median sleep duration was 6.1 h (5.2–6.8), bedtime and waking time *23:30 and 07:30, respectively. There were higher median weekly rates of SDH and PRH while asleep than clock-based nocturnal SDH and PRH among people with T1D, especially for SDH <70 mg/dL (1.7 vs. 1.4, P < 0.001). Higher weekly rates of SDH while asleep than nocturnal SDH were found among people with T2D, especially for SDH <70 mg/dL (0.8 vs. 0.7, P < 0.001). Conclusion: Using 00:00 to 06:00 as a proxy for sleeping hours may underestimate hypoglycemia while asleep. Future hypoglycemia research should consider the use of sleep trackers to record sleep and reflect hypoglycemia while asleep more accurately.

AB - Introduction: Nocturnal hypoglycemia is generally calculated between 00:00 and 06:00. However, those hours may not accurately reflect sleeping patterns and it is unknown whether this leads to bias. We therefore compared hypoglycemia rates while asleep with those of clock-based nocturnal hypoglycemia in adults with type 1 diabetes (T1D) or insulin-treated type 2 diabetes (T2D). Methods: Participants from the Hypo-METRICS study wore a blinded continuous glucose monitor and a Fitbit Charge 4 activity monitor for 10 weeks. They recorded details of episodes of hypoglycemia using a smartphone app. Sensor-detected hypoglycemia (SDH) and person-reported hypoglycemia (PRH) were categorized as nocturnal (00:00–06:00 h) versus diurnal and while asleep versus awake defined by Fitbit sleeping intervals. Paired-sample Wilcoxon tests were used to examine the differences in hypoglycemia rates. Results: A total of 574 participants [47% T1D, 45% women, 89% white, median (interquartile range) age 56 (45–66) years, and hemoglobin A1c 7.3% (6.8–8.0)] were included. Median sleep duration was 6.1 h (5.2–6.8), bedtime and waking time *23:30 and 07:30, respectively. There were higher median weekly rates of SDH and PRH while asleep than clock-based nocturnal SDH and PRH among people with T1D, especially for SDH <70 mg/dL (1.7 vs. 1.4, P < 0.001). Higher weekly rates of SDH while asleep than nocturnal SDH were found among people with T2D, especially for SDH <70 mg/dL (0.8 vs. 0.7, P < 0.001). Conclusion: Using 00:00 to 06:00 as a proxy for sleeping hours may underestimate hypoglycemia while asleep. Future hypoglycemia research should consider the use of sleep trackers to record sleep and reflect hypoglycemia while asleep more accurately.

KW - Continuous glucose monitoring

KW - Fitbit

KW - Hypo-METRICS

KW - Nocturnal hypoglycemia

KW - Sleep tracking

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U2 - 10.1089/dia.2023.0522

DO - 10.1089/dia.2023.0522

M3 - Article

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AN - SCOPUS:85191374013

SN - 1520-9156

VL - 26

SP - 433

EP - 441

JO - Diabetes Technology and Therapeutics

JF - Diabetes Technology and Therapeutics

IS - 7

ER -

A Comparison of the Rates of Clock-Based Nocturnal Hypoglycemia and Hypoglycemia While Asleep Among People Living with Diabetes: Findings from the Hypo-METRICS Study

Abstract

Keywords

UN SDGs

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