Sleep-AID: a cross-sectional analysis of subjective sleep quality, psychosocial measures and real-world glycemic outcomes in people with diabetes using automated insulin delivery systems

Abstract

Abstract Study Objectives Sleep disturbances are common in people with diabetes, yet their relationship to automated insulin delivery (AID) use has not been well described in large, real-world cohorts. We assessed subjective sleep quality, fear of hypoglycemia, and their associations with glycemic outcomes among adults with diabetes using open-source and commercial AID compared with non-users. abs10 Materials and Methods We conducted a cross-sectional analysis of 529 adults from the OPEN Project (2020–2023). Participants completed the Pittsburgh Sleep Quality Index (PSQI) and Hypoglycemia Fear Survey-II (HFS-II) short form. All participants self-reported glycated hemoglobin (HbA1c) levels; a subsample of 60 AID users contributed ≥25 days of continuous glucose monitoring (CGM) data. Free-text responses to PSQI item 5j were thematically coded. abs11 Results AID users reported better sleep (median 5 [IQR 3–7] vs. 7 [IQR 5–9],< .001) and lower fear of hypoglycemia (median 7 [IQR 3–11] vs. 13 [IQR 8–19],< .001) than non-users. Nevertheless, 43% of AID users and 69% of non-users exceeded poor sleep thresholds. Women reported worse PSQI and HFS-II scores than men (both< .001). Diabetes-related causes of sleep disruption were more common among non-users (< .05). PSQI and HFS-II scores correlated with HbA1c in the subsample, but associations with CGM metrics were not significant. abs12 Conclusions Adults using AID systems reported better sleep quality and lower fear of hypoglycemia than those managing diabetes without automation, yet a large proportion of all participants continued to experience poor sleep. Diabetes-related nocturnal disruptions remained common among non-users, suggesting that AID may alleviate—but not eliminate—the nighttime diabetes burden. Statement of Significance This is a first-of-its-kind study assessing subjective sleep quality, fear of hypoglycemia, diabetes outcome measures, continuous glucose monitoring (CGM)–derived glycemic metrics and free-text responses simultaneously, integrating quantitative and qualitative methods across a broad spectrum of people with diabetes including multiple diabetes subtypes and treatment paradigms. Our results show that while automated insulin delivery (AID) use is associated with better sleep quality and lessened fears of hypoglycemia, poor sleep still persists in all participant subgroups, indicating the need for more targeted approaches to improving sleep. Open-source AID users demonstrated better sleep quality than commercial users, which suggests that more granular control over AID system settings leads to better outcomes. Future studies should aim to recruit a more diverse cohort, and collect glucose data from all participant subgroups. abs5 box01 float portrait abs13