November is American Diabetes Month, and the American Diabetes Association reports that 322 billion dollars are spent on annual direct care costs and lost productivity due to diabetes and prediabetes. There are over 30 million Americans with the disease and the number is on the rise. One reason for the increase may be due to lack of sleep.

Both shortened sleep and disrupted sleep are associated with endocrine and metabolic changes.  Previous in-lab experiments have shown impaired glucose tolerance after 1 week of restricting sleep. Americans are now sleeping a little over 6 hours per night on average and more than 30% report sleeping less than 6 hours per night. This reduction in sleep may be one reason for the increase in diabetes nationwide. Shortened sleep is also associated with cardiovascular disease, hypertension, and obesity.

Data from a recent longitudinal study, involving a group of American Indians and Alaska Natives, both high-risk groups for diabetes, showed that there was a significant association between short sleep duration and the increased risk of diabetes.1

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Approximately 1900 individuals were studied over a 3-year period. Eligible participants did not have a previous diagnosis of diabetes, but all had either an impaired fasting glucose or impaired glucose tolerance test.

The results showed that the short sleepers were significantly less likely to report that they felt they were in good health. Of the group of individuals that slept less than 6 hours per night, 91 developed diabetes. The crude diabetes rate for this group was 4.6 per 100 person-years compared to 3.2 per 100 person-years among those who slept more than 7 hours.

Short sleepers also tended to snack more often and ate more carbohydrate-rich and fatty foods. This has been noted in other cross-sectional studies, as patients tend to gravitate toward these food groups when they are tired. Short sleep duration has been associated with decreased leptin and elevated ghrelin levels, which alters appetite regulation and increases hunger.

Remember to question whether your patients are getting adequate sleep, especially among those with diabetes. Mounting evidence points to an increased risk of diabetes in patients who are sleep deprived.

Click here to learn more about American Diabetes Month.

Sharon M. O’Brien, MPAS, PA-C, is a practicing physician assistant and health coach in Asheville, NC.


  1.  Nuyujukian DS, Beals J, Huang H, et al. Sleep duration and diabetes risk in American Indian and Alaska native participants of a lifestyle intervention project. Sleep. 2016;39(11):1919–1926.