Sleep duration and risk of microvascular complications in type 2 diabetes: A prospective cohort study.

BACKGROUND

Longitudinal evidence on sleep duration's effects on type 2 diabetes mellitus (T2DM) microvascular outcomes, particularly in Asian populations, remains limited. This study investigated the prospective association between sleep duration and microvascular complication incidence in T2DM patients.

METHODS

This prospective cohort included 1236 T2DM adults, free of microvascular complications at baseline from National Metabolic Management Centre Ningbo Branch (2018-2023). Self-reported sleep duration was categorized into 5 groups (<7, 7-8, 8-9, 9-10, or ≥10h). Incident diabetic kidney disease (DKD), retinopathy (DR), and peripheral neuropathy (DPN) were ascertained. Cox regression and restricted cubic spline analyses estimated hazard ratio (HRs) and dose-response relationships.

RESULTS

In 2459 person-years, 237 participants developed microvascular complications. A U-shaped association emerged between sleep duration and composite microvascular complications (P < 0.001) and DPN (P = 0.039), with lowest risk at 7-8h. Compared to 7-8h, shorter (<7h) and longer (≥10h) durations significantly increased composite microvascular complication risks (HR = 1.71, P = 0.018; HR = 1.87, P = 0.005). No statistically significant interactions were observed between sleep duration and age, BMI, sedentary time, or sleep quality (all P for interaction >0.05).

CONCLUSION

Both insufficient and excessive sleep increase T2DM microvascular complication risks. Maintaining 7-8 h of sleep daily may be a vital behavioral target in comprehensive T2DM management, potentially reducing microvascular complication burden.