SUN-618 - Poor Sleep Quality and Reduced Melatonin Secretion Are Associated with Severe Diabetic Neuropathy in Type 2 Diabetes

Objective: This cross-sectional comparative study aimed to evaluate the impact of sleep quality on metabolic control, melatonin secretion, and neuropathy severity in patients with Type 2 Diabetes Mellitus (T2DM). The study specifically investigated correlations between sleep parameters, glycemic variability, and the potential mediating role of melatonin levels in T2DM progression and associated complications.

Methods: T2DM patients were divided into two groups based on their Pittsburgh Sleep Quality Index scores: preserved sleep quality and poor sleep quality. Clinical and laboratory assessments included disease duration, glycemic control (fasting glucose, postprandial glucose, HbA1c), lipid profile, daily urinary melatonin excretion, and neuropathy severity. Statistical analysis involved parametric or non-parametric tests, Pearson or Spearman correlations, and multivariate linear regression.

Results: Patients with poor sleep quality were significantly older (62.37 ± 4.80 vs 58.05 ± 5.08 years, p < 0.001) and had a longer disease duration (10.55 ± 3.34 vs 4.55 ± 2.60 years, p < 0.001). Group 2 also demonstrated worse glycemic control, with higher fasting glucose (8.92 ± 1.97 vs 7.53 ± 1.45 mmol/L, p = 0.002) and postprandial glucose (14.53 ± 3.92 vs 12.04 ± 3.52 mmol/L, p = 0.010). A severe melatonin deficiency was observed in Group 2 (31.97 ± 13.00 ng/day vs 77.56 ± 16.26 ng/day, p < 0.001). Furthermore, patients with poor sleep quality exhibited markedly more severe neuropathy, indicated by higher NSS (5.81 ± 2.37 vs 0.68 ± 0.72, p < 0.001) and TSS scores (2.54 ± 0.83 vs 0.61 ± 0.58, p < 0.001), with more frequent peripheral nerve involvement. Correlation analysis in Group 2 revealed strong associations between neuropathy severity and PSQI score (r = 0.62, p < 0.001; r = 0.58, p < 0.001 respectively) and urinary melatonin (r = –0.65, p < 0.001; r = –0.60, p < 0.001 respectively). Multivariate regression analysis identified reduced urinary melatonin excretion (β = –0.37, p < 0.001), longer diabetes duration (β = 0.34, p = 0.002), and poor sleep quality (PSQI score, β = 0.29, p = 0.004) as independent predictors of neuropathy severity.

Conclusion: Patients with T2DM and poor sleep quality exhibit significantly lower melatonin secretion and more severe diabetic neuropathy. This suggests that sleep quality impairment and melatonin deficiency are independently associated with the progression of diabetic neuropathy, highlighting them as potential targets for intervention in T2DM management.

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