Sleep Duration, Lifestyle Intervention, and Incidence of Type 2 Diabetes in Impaired Glucose Tolerance

• Published in: Diabetes care Vol. 32; no. 11; pp. 1965 - 1971
• Main Authors: Tuomilehto, Henri, Peltonen, Markku, Partinen, Markku, Lavigne, Gilles, Eriksson, Johan G., Herder, Christian, Aunola, Sirkka, Keinänen-Kiukaanniemi, Sirkka, Ilanne-Parikka, Pirjo, Uusitupa, Matti, Tuomilehto, Jaakko, Lindström, Jaana
• Format: Journal Article
• Language: English
• Published: American Diabetes Association 01-11-2009
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc08-1980

Sleep Duration, Lifestyle Intervention, and Incidence of Type 2 Diabetes in Impaired Glucose Tolerance
The Finnish Diabetes Prevention Study
Henri Tuomilehto , MD, PHD 1 , 2 ,
Markku Peltonen , PHD 3 ,
Markku Partinen , MD, PHD 4 ,
Gilles Lavigne , DMD, PHD 2 ,
Johan G. Eriksson , MD, PHD 3 , 5 , 6 ,
Christian Herder , PHD 7 ,
Sirkka Aunola , PHD 8 ,
Sirkka Keinänen-Kiukaanniemi , MD, PHD 9 ,
Pirjo Ilanne-Parikka , MD 10 ,
Matti Uusitupa , MD, PHD 11 ,
Jaakko Tuomilehto , MD, PHD 12 ,
Jaana Lindström , PHD 3 and
on behalf of the Finnish Diabetes Prevention Study Group
1 Department of Otorhinolaryngology, Kuopio University Hospital, and University of Kuopio, Kuopio, Finland;
2 Faculty of Dental Medicine, Université de Montréal, Montréal, Quebec, Canada;
3 Diabetes Unit, Department of Health Promotion and Chronic Diseases Prevention, National Public Health Institute, Helsinki,
Finland;
4 Skogby Sleep Clinic, Rinnekoti Research, Espoo, Finland, and Department of Neurology, University of Helsinki, Helsinki, Finland;
5 Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland;
6 Vasa Central Hospital, Vasa, Finland;
7 Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University
Düsseldorf, Düsseldorf, Germany;
8 Laboratory for Population Research, National Public Health Institute, Helsinki, Finland;
9 Institute of Health Sciences, University of Oulu, Oulu, Finland;
10 Diabetes Center, Finnish Diabetes Association, Tampere, Finland;
11 School of Public Health and Clinical Nutrition, University of Kuopio, Kuopio, Finland;
12 Department of Public Health, University of Helsinki, Helsinki, Finland, and South Ostrobothnia Central Hospital, Seinäjoki,
Finland.
Corresponding author: Henri Tuomilehto, henri.tuomilehto{at}kuh.fi .
Abstract
OBJECTIVE Both short and long sleep duration have frequently been found to be associated with an increased risk for diabetes. The aim
of the present exploratory analysis was to examine the association between sleep duration and type 2 diabetes after lifestyle
intervention in overweight individuals with impaired glucose tolerance in a 7-year prospective follow-up.
RESEARCH DESIGN AND METHODS A total of 522 individuals (aged 40–64 years) were randomly allocated either to an intensive diet-exercise counseling group
or to a control group. Diabetes incidence during follow-up was calculated according to sleep duration at baseline. Sleep duration
was obtained for a 24-h period. Physical activity, dietary intakes, body weight, and immune mediators (C-reactive protein
and interleukin-6) were measured.
RESULTS Interaction between sleep duration and treatment group was statistically significant ( P = 0.003). In the control group, the adjusted hazard ratios (HRs) (95% CI) for diabetes were 2.29 (1.38–3.80) and 2.74 (1.67–4.50)
in the sleep duration groups 9–9.5 h and ≥10 h, respectively, compared with for that of the 7–8.5 h group. In contrast, sleep
duration did not influence the incidence of diabetes in the intervention group; for sleep duration groups 9–9.5 h and ≥10
h, the adjusted HRs (95% CI) were 1.10 (0.60–2.01) and 0.73 (0.34–1.56), respectively, compared with that in the reference
group (7–8.5 h sleep). Lifestyle intervention resulted in similar improvement in body weight, insulin sensitivity, and immune
mediator levels regardless of sleep duration.
CONCLUSIONS Long sleep duration is associated with increased type 2 diabetes risk. Lifestyle intervention with the aim of weight reduction,
healthy diet, and increased physical activity may ameliorate some of this excess risk.
Footnotes
Clinical trial reg. no. NCT00518167, clinicaltrials.gov
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore
be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
Received November 3, 2008.
Accepted July 20, 2009.
© 2009 by the American Diabetes Association.