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

The Finnish Diabetes Prevention Study

  1. Henri Tuomilehto, MD, PHD1,2,
  2. Markku Peltonen, PHD3,
  3. Markku Partinen, MD, PHD4,
  4. Gilles Lavigne, DMD, PHD2,
  5. Johan G. Eriksson, MD, PHD3,5,6,
  6. Christian Herder, PHD7,
  7. Sirkka Aunola, PHD8,
  8. Sirkka Keinänen-Kiukaanniemi, MD, PHD9,
  9. Pirjo Ilanne-Parikka, MD10,
  10. Matti Uusitupa, MD, PHD11,
  11. Jaakko Tuomilehto, MD, PHD12,
  12. Jaana Lindström, PHD3 and
  13. on behalf of the Finnish Diabetes Prevention Study Group
  1. 1Department of Otorhinolaryngology, Kuopio University Hospital, and University of Kuopio, Kuopio, Finland;
  2. 2Faculty of Dental Medicine, Université de Montréal, Montréal, Quebec, Canada;
  3. 3Diabetes Unit, Department of Health Promotion and Chronic Diseases Prevention, National Public Health Institute, Helsinki, Finland;
  4. 4Skogby Sleep Clinic, Rinnekoti Research, Espoo, Finland, and Department of Neurology, University of Helsinki, Helsinki, Finland;
  5. 5Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland;
  6. 6Vasa Central Hospital, Vasa, Finland;
  7. 7Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany;
  8. 8Laboratory for Population Research, National Public Health Institute, Helsinki, Finland;
  9. 9Institute of Health Sciences, University of Oulu, Oulu, Finland;
  10. 10Diabetes Center, Finnish Diabetes Association, Tampere, Finland;
  11. 11School of Public Health and Clinical Nutrition, University of Kuopio, Kuopio, Finland;
  12. 12Department of Public Health, University of Helsinki, Helsinki, Finland, and South Ostrobothnia Central Hospital, Seinäjoki, Finland.
  1. Corresponding author: Henri Tuomilehto, henri.tuomilehto{at}


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.


  • Clinical trial reg. no. NCT00518167,

  • 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.
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  1. Diabetes Care vol. 32 no. 11 1965-1971
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