Association Between Excessive Daytime Sleepiness and Severe Hypoglycemia in People With Type 2 Diabetes

The Edinburgh Type 2 Diabetes Study

  1. Rebecca M. Reynolds, PHD5
  1. 1Department of Diabetes, Royal Infirmary of Edinburgh, Edinburgh, U.K.
  2. 2Department of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, U.K.
  3. 3Metabolic Unit, Western General Hospital, Edinburgh, U.K.
  4. 4Centre for Population Health Sciences, University of Edinburgh, Edinburgh, U.K.
  5. 5Endocrinology Unit, Centre for Cardiovascular Sciences, Queen’s Medical Research Institute, Edinburgh, U.K.
  1. Corresponding author: Rebecca M. Reynolds, r.reynolds{at}


OBJECTIVE Sleep-disordered breathing and sleepiness cause metabolic, cognitive, and behavioral disturbance. Sleep-disordered breathing is common in type 2 diabetes, a condition which requires adherence to complex dietary, behavioral, and drug treatment regimens. Hypoglycemia is an important side effect of treatment, causing physical and psychological harm and limiting ability to achieve optimal glycemic control. We hypothesized that sleep disorder might increase the risk of hypoglycemia through effects on self-management and glucose regulation.

RESEARCH DESIGN AND METHODS People with type 2 diabetes (n = 898) completed questionnaires to assess sleep-disordered breathing, daytime sleepiness, and occurrence of severe hypoglycemia.

RESULTS Subjects who scored highly on the Epworth Sleepiness Scale were significantly more likely to have suffered from severe hypoglycemia. This was a significant predictor of severe hypoglycemia in regression analysis including the variables age, sex, duration of diabetes, HbA1c, BMI, and treatment type.

CONCLUSIONS Daytime sleepiness may be a novel risk factor for hypoglycemia.

  • Received April 12, 2013.
  • Accepted June 29, 2013.

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This Article

  1. Diabetes Care
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