# Healthy Sleep Behaviors Reduce the Risk of Microvascular and Cardiovascular Complications in Patients With Type 2 Diabetes and Are Associated With Potential Serum Biomarkers: A UK Biobank Observational Cohort Study

## TL;DR

Better sleep habits lower the risk of diabetes-related complications and are linked to specific blood markers in a large study of type 2 diabetes patients.

## Contribution

Identifies serum biomarkers that partially explain how healthy sleep reduces diabetes complications.

## Key findings

- Healthy sleep scores were linked to 30% lower microvascular complication risk and 30% lower cardiovascular risk.
- Cystatin C explained 30.36% of the sleep-complication link for microvascular issues.
- Biomarkers like Cys C and CRP partially mediate the relationship between sleep and diabetes complications.

## Abstract

The association of sleep behaviors with microvascular complications and cardiovascular outcomes in diabetic patients is not clear. Furthermore, serum biomarkers that can be used to evaluate this association have not been characterized. Therefore, this study investigated the association of the overall sleep score with the diabetic complications and the potential underlying serum metabolic biomarkers in patients with type 2 diabetes mellitus (T2DM).

This prospective cohort study included 30 915 T2DM patients without complications from the UK Biobank. The sleep score of the participants was evaluated based on sleep behaviors such as sleep duration, insomnia, snoring, chronotype, and daytime sleepiness. The potential biomarkers, including cystatin C (Cys C), apolipoprotein A (Apo A), C‐reactive protein (CRP), albumin, and γ‐glutamyl transpeptidase (GGT), were also determined to evaluate their role as potential indicators of the association between the sleep score and the diabetic complications.

Participants with a healthy sleep score of 4–5 had lower risks of microvascular complications (HR = 0.80 [95% CI: 0.72, 0.89]) and cardiovascular outcomes (HR = 0.70 [95% CI: 0.61, 0.81]) compared to those with a sleep score of 0–1. Furthermore, cys C showed the best effects by explaining the associations of overall healthy sleep behaviors with microvascular complications and cardiovascular outcomes by 30.36% and 14.36%, respectively.

Our data showed that healthy sleep behaviors were associated with a reduced risk of diabetic complications. Moreover, serum biomarkers of renal function, lipids, systemic inflammation, and hepatic function partially mediated the relationship between sleep behaviors and diabetic complications.

Multivariable‐adjusted incident risk of complications according to healthy sleep score among 30 915 T2D participants.