2) Our expert faculty is Dr Kevin Fernando @drkevinfernando, FRCGP FRCP Edin, FAcadMEd MSc Diabetes, GP with Specialist Interest in CVRM & Medical Education. See statement of accreditation and faculty disclosures at https://t.co/gvXca4G9Xm. pic.twitter.com/dxo3e5HElU
— cardio-met (@cardiomet_CE) January 3, 2023
4) In #Maslow’s hierarchy of needs, sleep is positioned at the foundation alongside food, shelter, air & water.
— cardio-met (@cardiomet_CE) January 3, 2023
💤We need sleep to function at the most basic level and without sleep we cannot achieve the other levels of needs pic.twitter.com/SHaXUP5AkP
5b) Specifically, younger adults aged 35-44 years got the least sleep with nearly half only getting 5-6 hours per night. Worryingly, 1 in 10 individuals were only getting 2-4 hours sleep per night, significantly less than the recommended 7-8 hours. pic.twitter.com/dAsxfcx6r7
— cardio-met (@cardiomet_CE) January 3, 2023
6b) Indeed, <2% of hunter-gatherer populations in Namibia & Bolivia showed signs of insomnia cf. up to 30% in industrial societies. See 🔓https://t.co/V2iud7svr5.
— cardio-met (@cardiomet_CE) January 3, 2023
8) The recently updated @AmDiabetesAssn / @EASDnews 2022 consensus report positions #sleep as a key 24-hour physical behaviour for managing #T2D.
— cardio-met (@cardiomet_CE) January 3, 2023
People living with T2D should aim for consistent uninterrupted sleep even on the weekends. pic.twitter.com/9Wqx59hR1i
10) #Chronotype (our natural inclination to sleep at a certain time e.g., “early birds” or “night owls”) also plays a pivotal role as evening chronotypes may be more susceptible to inactivity & suboptimal glucose levels. pic.twitter.com/mAawDqWWXm
— cardio-met (@cardiomet_CE) January 3, 2023
12a) A high-quality meta-analysis 🔓https://t.co/ujpyGTXiLp demonstrated a U-shaped curve with both very short & overly long sleep durations ⬆️risk of developing #T2D. The lowest risk of developing T2D appeared to be around 7-8 hours sleep.
— cardio-met (@cardiomet_CE) January 3, 2023
13a) A recent cohort study https://t.co/9BGKMCEGvT investigated the risk of #T2D in patients with and without #insomnia.
— cardio-met (@cardiomet_CE) January 3, 2023
💤Those with insomnia had a 16% ⬆️ risk of developing T2D. The overall risk of developing T2D appeared ⬆️ in those under the age of 40 years
14a) How does sleep duration affect people who are already at ⬆️ risk of developing #T2D (“pre-diabetes”)?
— cardio-met (@cardiomet_CE) January 3, 2023
👉A very recent SR & MA 🔓https://t.co/MuKvEIGkMk explored the impact of sleep behaviours and associated habits on the progression of pre-diabetes to T2D in adults
15) ACTION POINT 🧨: Aside from the usual signposting & lifestyle advice for those with #pre_diabetes we should also counsel about adequate sleep duration to mitigate progression to #T2D
— cardio-met (@cardiomet_CE) January 3, 2023
16b) ACTION POINT 🧨: Do we know which of our patients at risk of developing #T2D work night shift and have we counselled them appropriately? pic.twitter.com/E7CwzEvBoU
— cardio-met (@cardiomet_CE) January 3, 2023
17b) If we extrapolate this #HbA1c ⬇️ to the results of the seminal #UKPDS https://t.co/RZWp8JKjxV , this equates to a clinically significant 3% ⬇️ in death from #T2D, a ⬇️in myocardial infarction and a 5% ⬇️ in microvascular disease.
— cardio-met (@cardiomet_CE) January 3, 2023
18) So let's pause for a knowledge ✔️& see what you have learned. Improved sleep hygiene has been shown to do all but which of the following?
— cardio-met (@cardiomet_CE) January 3, 2023
a. ⬇️incidence of hypoglycemia
b. ⬇️progression pre-diabetes to #T2D
c. ⬇️#HbA1c
d. ⬇️#bloodpressure in persons with #hypertension
20) Welcome back! I am @drkevinfernando & we are talking the connections between #T2D & disordered sleep . . . I call it "The Sleeping Giant". Thanks for joining us! Follow this 🧵for 0.5 hr 🆓CE/#CME 🇬🇧🇺🇸🇨🇦🇪🇺
— cardio-met (@cardiomet_CE) January 4, 2023
👉Yesterday's quiz? The correct answer is A (see tweets 11, 13, 14)
21b) #OSAHS affects around 6-13% of adults in the 🇬🇧. viz. it is as least as common as #T2D, but remains underdiagnosed in primary care. pic.twitter.com/O1LMOjnNl6
— cardio-met (@cardiomet_CE) January 4, 2023
23a) There is a higher ⬆️ of #OSAHS in people living with #T2D; around 25% of people living with T2D have OSAHS
— cardio-met (@cardiomet_CE) January 4, 2023
👉Conversely, around 15-30% of people living with OSAHS have T2D
23c) #OSA was associated with a 37% ⬆️ risk of #T2D (independent of demographic, lifestyle, co-morbidities & anthropometric factors) whereas people living with T2D & treated with insulin had a 43% ⬆️ risk of OSA (independent of #adiposity) particularly women. Bidirectional!
— cardio-met (@cardiomet_CE) January 4, 2023
24) ACTION POINT 🧨: Check an #HbA1c in all patients with #OSAHS & not known to have #T2D
— cardio-met (@cardiomet_CE) January 4, 2023
ACTION POINT 🧨: Consider screening for OSAHS in all patients living with T2D & not known to have any sleep disorders using the #Epworth_sleepiness_scale & #STOP_Bang questionnaire pic.twitter.com/deCJubalGq
25b) #OSA was an independent predictor of progression to pre-proliferative & proliferative DR over 4 years
— cardio-met (@cardiomet_CE) January 4, 2023
👉Treatment of OSA with continuous positive airways pressure (#CPAP) therapy was associated with a ⬇️ in pre-proliferative & proliferative DR pic.twitter.com/bT761wvrze
27) Finally, how do we as #HCPs & our patients practice healthy sleep hygiene? pic.twitter.com/2aM8dc2y17
— cardio-met (@cardiomet_CE) January 4, 2023
29a) Some further detail on #screentime & #blue_light exposure…#Melatonin is secreted by the #pineal gland during darkness and helps regulate our #circadian rhythms
— cardio-met (@cardiomet_CE) January 4, 2023
30) Here are some great resources for sleep hygiene: pic.twitter.com/vtqzU0ui6D
— cardio-met (@cardiomet_CE) January 4, 2023
32) 1⃣ We need to wake up to sleep as a major #metabolic risk factor: enquiring & counselling about sleep quality & sleep duration should be integral to every #diabetes consultation pic.twitter.com/OY6qz5sXyK
— cardio-met (@cardiomet_CE) January 4, 2023
34) 3⃣ #Sleep_hygiene is more than just a bedtime buzzword; counsel patients how to practice healthy sleep hygiene but individualise, modify, and compromise where necessary! pic.twitter.com/8wIxrRdJho
— cardio-met (@cardiomet_CE) January 4, 2023
35b) You got it–a & c, right? The #PSQI is a self-report questionnaire that assesses sleep quality over a 1-month time interval, but is less sensitive than the other two as a screen for #OSA.
— cardio-met (@cardiomet_CE) January 4, 2023
💤 And now . . . you have earned some rest!!
36) Click 🖱️ to https://t.co/6r9hTsicmt and claim your 🆓0.5hr CE/#CME certificate. We trust you didn't sleep-walk through this program. FOLLOW US for more expert-led accredited education delivered wholly on Twitter! I am @drkevinfernando
— cardio-met (@cardiomet_CE) January 4, 2023