683-P: Association between Glycaemic Variability and Sleep in Adults with Type 1 and Type 2 Diabetes-A Systematic Review

Context: Individuals with diabetes frequently encounter sleep disturbances, which can detrimentally impact glycemic management. We review the relationship between sleep and glycemic variability in adults with diabetes. Methods: We systematically searched Medline, EMBASE, and Cochrane Library (2002-March 2023) for studies evaluating sleep and glycemic variability metrics in adults with type 1 and type 2 diabetes. Results: Among 3,049 records, 26 met inclusion criteria (type 1 diabetes studies=21). Due to methodological heterogeneity, a qualitative analysis was conducted. Most studies measuring sleep quality (5 out 7; 71%) reported a significant association with glycemic variability in type 1 and type 2 diabetes. In type 1 diabetes, sleep duration showed no significant association with glycemic variability, while other sleep metrics yielded inconclusive results. Hybrid closed-loop pump interventions (n=12) demonstrated varying sleep outcomes but consistently improved glycemic variability. Conversely, sleep interventions (n=3) enhanced sleep but not glycemic variability. Limitations included moderate to high-risk of study bias, confounders, methodological heterogeneity, and limited type 2 diabetes data. Conclusion: A potential association between sleep quality and glycemic variability exists. However, associations with other sleep metrics remain elusive, with no discernible association between sleep duration and glycemic variability in type 1 diabetes. Despite advancements in continuous glucose monitoring and ambulatory sleep monitoring, standardized sleep assessment methodologies are lacking in real-world research. Establishing standard protocols for sleep assessment and defining optimal sleep targets is crucial for meaningful comparisons between studies. Understanding the complex interplay between sleep and glycemic variability holds promise for improving diabetes management and sleep health.