Sleep Quality and Glycemic Control in Type 1 Diabetes: A Retrospective Cohort Study Using Advanced Technological Devices

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear Authors,

This is interesting manuscript, but I have many remarks:

1.     Abstract- line 30- TAR abbreviation should be properly explained- as Time above Range

2.     Introduction lines 40-60- this part is not the subject of manuscript. I suggest to explain how diabetes disturb patients life, how many of patients have sleep problems and depression. What are the reasons of sleep disturbances in population  with diabetes. In contrary what literature says about how new equipment improve patients  quality of life and glycemic control.

3.     Study group – there is no information how long patients used this type of treatment, without changes.- it should be more than 3-5 months before the study- and this information should be in the methods description. There is no information how many of patients using Medtronic 780 G used the Smart Guard , or Manual- group should be in one option of treatment.

4.     Sample and criteria- why the study group is not unify with one insulinotherapy method. If You have no possibility You should include more patients and divide groups with different treatment method. Such not uniformity is big methodological mistake.

5.     Whether corrections of statistical analyses were made due to small groups of respondents

6.     I suggest increasing study group.

7.     Exclusion criteria- please explain why you chose such assessments, ignoring other pain diseases and e.g. depression , which significantly disturb sleep, and pharmacotherapy of sleep disturbances.

8.     I suggest wider analysing differences between MDI and AHCL

9.     Please try to explain results :why patients with shorter diabetes duration have bigger sleep problems.

10.  Lines 185-186- please present the data in a clearer way and to facilitate inference.

 

11.  Line 215- please add link to reference which is lack

 

Author Response

Dear Review,

please accept our reply.

The authors

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The study investigates the relationship between sleep quality and glycemic control in patients with T1D using advanced technological devices, specifically Medtronic CGM systems. This retrospective observational study assesses how sleep disturbances may affect glycemic outcomes in T1D patients. Sleep quality was assessed using the Pittsburgh Sleep Quality Index, and glycemic outcomes were analyzed through CGM data over 30 days before the PSQI assessment. The statistical analysis employed non-parametric tests to compare sleep quality scores and glycemic metrics between good and poor sleepers. The results show that ~36% of participants exhibited poor sleep quality (PSQI > 5). Poor sleepers demonstrated significantly higher TAR2 during bedtime than good sleepers, suggesting a correlation between sleep quality and glycemic control.

The study contributes valuable insights into the interplay between sleep quality and glycemic control in T1D patients. While the discussion highlights important implications for diabetes management, it lacks depth in exploring how sleep interventions could be practically integrated into existing care protocols. The discussion section could be improved.

The small sample size is a limitation of the study; however, I find the paper well-written, and I congratulate the authors for the idea.

Author Response

Dear peer,

please accept our reply.

The authors

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Reviewer 3 Report

Comments and Suggestions for Authors

The study addresses a critical and underexplored area in diabetes care: the relationship between sleep quality and glycemic control in Type 1 Diabetes (T1D). Given the growing use of continuous glucose monitoring (CGM) and advanced technological devices, this research is both timely and practical.

The study includes only 41 participants after exclusions, which limits the generalizability of the findings.

While the study notes no significant differences in age, sex, BMI, or diabetes duration between groups, it does not discuss other potential confounders such as stress, physical activity, or comorbid conditions that could influence sleep or glycemic control.

This study highlights the potential advantages of incorporating sleep measurements into diabetes management by offering insightful information about the relationship between glycaemic control and sleep quality in people with type 1 diabetes. Notwithstanding its drawbacks, it provides a solid framework for further studies that examine sleep therapies as a way to enhance diabetes care. This area of research has the potential to greatly improve patient outcomes in T1D management with more development and refining.

Author Response

Dear peer,

please accept our reply.

The authors

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Reviewer 4 Report

Comments and Suggestions for Authors

Thank you for the opportunity to review the article entitled "The Impact of Sleep Quality on Glycemic Control in Type 1 Diabetes: A Retrospective Study in Cohort Using Advanced Technological Devices".

 

The abstract and introduction briefly but effectively introduce the potential reader to the scope of the article, I have no objections to these sections of the manuscript.

 

The methodological part does not provide significant issues; however, it would be prudent to include further details concerning the exclusion criteria, specifically the rationale for each criterion's exclusion - I ask the authors to consider this. In the statistics section, it would also be appropriate to include a calculation of the minimum sample size (did the authors undertake such an assessment?). 

 

The main disadvantage in the results section is the limited number of subgroups, which may influence the significance of the observed differences. In the table descriptions, it would enhance readability to present specific glycemia values rather than the abbreviations TBR1, TBR2, TAR1, and TAR2. There is also no attempt to assess the differences between estimated HbA1c based on CGM results - do the authors have such results?

 

The results and discussion (very short, by the way - it should be expanded) do not address the question regarding the influence of sleep quality on glycemic control, but rather talk about the mutual relationship between the two - I would suggest changing the title of the manuscript to one that better reflects reality. 

 

Based on the above, I would also suggest the authors consider expanding the "limitations" subsection. 

 

The work possesses potential; yet, it necessitates corrections. I would be willing to conduct a second review after revisions.

Author Response

Dear peer,

please accept our reply.

The authors

Author Response File: Author Response.pdf

Reviewer 5 Report

Comments and Suggestions for Authors

 

This study – a retrospective one - tried to explain association or not between “Sleep Quality and Glycemic Control in Type 1 Di- 2Abetes using Advanced Tech- 3nological Devices”. We can not say that a good glycemic control impact the quality of sleep of vice versa using a retrospective study, it is logical and statistically correct to use an association between both affirmation (or not).

 

This study could be a real original one because the authors could exploit their data in an original way. And yes, the study will bring some information in this area.

 

The quality of data is superior. A lot of patients with type 1 DM and questioned about quality of sleep. Other published articles did not explore a large cohort of subjects.

 

The methodology should be improved. The authors should present the association or not between quality of sleep and TIR (or TBR) – using ASSOCIATION COEFICIENT. The methodology should be clear improved.

 

 

“No statistically significant differences were observed between 236 good and poor sleepers in terms of age, sex, BMI, diabetes duration, smoking habit, device 237 used for diabetes management, and glycemic outcomes during the 30 days preceding the 238 PSQI assessment.” – this is a sign that the lot should be increased or the methodology is not adequate.

  

The methodology is wrong used for a retrospective study.

 

 

References are appropriate.

 

The references are carefully chosen, from impact journals. They are updated, from the last 10-12 years, in the area of type 1 diabetes mellitus . They constitute a real support for the text of the article.

 

American Diabetes Association Professional Practice Committee. 7. Diabetes Technology: Standards of Care in Diabetes-2024. 369

Diabetes Care. 2024, Jan 1;47(Suppl 1):S126-S144. doi: 10.2337/dc24-S007.  – is a new version already on their website (2025).

 

 

 

Figures and tables are very easy to understand, compare the groups of patients studied. But the methodology is not well sustained.

 

The authors should increase the lot, the observational time, or change the methodology.

Author Response

Dear peer,

please accept iur reply.

The authors.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Dear Authors, 

Thank You for the improvement of the manuscript.

Author Response

Dear Peer,

thank you very much for your valuable comment.

Best

Reviewer 4 Report

Comments and Suggestions for Authors

Thank you for the opportunity to review the article entitled (after change) "Sleep Quality and Glycemic Control in Type 1 Diabetes: A Retrospective Cohort Study Using Advanced Technological Devices".

The authors correctly addressed most of the previous comments.

However, I would like to draw attention to an element not taken into account by the authors, which I will allow myself to quote again: "There is also no attempt to assess the differences between estimated HbA1c based on CGM results - do the authors have such results?"

Furthermore, in the comment regarding the limited number of patients in subgroups, concerns were raised about the appropriate use of statistical methods - the authors did add information on this subject in lines 189-191, but it seems insufficient (what "statistical corrections" were specifically used?).

The manuscript is of significantly better quality, but requires further corrections.

Author Response

Dear Peer,

thank you for your valuable comments. We hope that in this form you'll accept the manuscript.

Thank you again for your time and efforts.

Best

Author Response File: Author Response.pdf

Reviewer 5 Report

Comments and Suggestions for Authors

Dear Authors, 

For my point of view, this version is ready to be published. 

Author Response

Dear Peer,

thank you for your valuable comments.

Best

Round 3

Reviewer 4 Report

Comments and Suggestions for Authors

The authors have appropriately addressed previous comments - I have no additional comments.