The relationship between the frequency of hypoglycemic episodes, quality of life, and subjective sleep characteristics in patients with type 1 diabetes mellitus

Karamullina R.A., Ismailova S.M., Lutoshkina E.D., Poluboyarinova I.V., Poluektov M.G., Fadeev V.V.

Department of Endocrinology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia

Background: In patients with type 1 diabetes mellitus, factors such as the development of hypoglycemic episodes, fear of hypoglycemia, and signals from CGM devices may additionally influence the qualitative and quantitative characteristics of sleep. Although the duration and quality of sleep in patients with type 1 diabetes mellitus (DM1) are comparable in polysomnographic studies and in individuals without carbohydrate metabolism disorders, DM1 patients subjectively rate their sleep as less restorative, potentially further negatively impacting quality of life in this cohort.
Objective: Evaluation of the relationship between the frequency of hypoglycemic episodes, subjective sleep quality, daytime sleepiness, and quality of life indicators in DM1 patients.
Materials and methods: An observational, cross-sectional clinical study involving 74 patients with type 1 diabetes mellitus was conducted. All patients underwent an examination that included an assessment of their history of hypoglycemic episodes, quality of life using the SF-36 questionnaire, and subjective sleep assessment using the Spiegel Sleep Rating Scale and the Epworth Sleepiness Scale. 
Results: Analysis of standardized quality-of-life measures showed that the group of patients with less frequent hypoglycemia episodes had better quality-of-life scores across all SF-36 scales. Moreover, an increase in the frequency of hypoglycemia episodes did not lead to a subjective decrease in sleep quality as measured by the Spiegel Sleepiness Scale or an increase in daytime sleepiness as measured by the Epworth Sleepiness Scale. Patients with significant daytime sleepiness (more than 10 points on the Epworth Sleepiness Scale) had significantly lower total SF-36 scores and physical component scores. However, patients with lower sleep quality as measured by the Spiegel Sleep Questionnaire did not show statistically significant differences across any of the SF-36 scales.
Conclusion: In DM1 patients, hypoglycemia is an additional factor reducing quality of life: in addition to severe physical discomfort and stress, it can cause qualitative and quantitative changes in sleep. In turn, sleep disorders and associated daytime sleepiness significantly impair daily functioning and subjective well-being in patients, increasing the overall burden of the disease.

For citations: Karamullina R.A., Ismailova S.M., Lutoshkina E.D., Poluboyarinova I.V., Poluektov M.G., Fadeev V.V. The relationship between the frequency of hypoglycemic episodes, quality of life, and subjective sleep characteristics in patients with type 1 diabetes mellitus. Pharmateca. 2026;33(2):65-70. (In Russ.). DOI: https://dx.doi.org/10.18565/pharmateca.2026.2.65-70

Authors’ contribution: R.A. Karamullina – significant contribution to data collection, analysis, and interpretation of the results, as well as to writing the article. S.M. Ismailova – significant contribution to data collection, analysis, and writing the article. E.D. Lutoshkina – significant contribution to obtaining, analyzing the data and interpreting the results, and writing the article. I.V. Poluboyarinova – significant contribution to the study concept and design, data analysis and interpretation of the results, and revisions to the manuscript to enhance the scientific value of the article. M.G. Poluektov – significant contribution to obtaining, analyzing the data and interpreting the results. V.V. Fadeev – significant contribution to the concept study and design, data analysis and interpretation of the results, and revisions to the manuscript to enhance the scientific value of the article. 
All authors approved the final version of the article before publication and agreed to be accountable for all aspects of the work, including appropriately investigating and resolving questions related to the accuracy or integrity of any part of the work.
Conflicts of interest: The authors confirm that they have no conflicts of interest to declare.
Funding: The study was funded by the authors.
Ethical Approval: The study was approved at a meeting of the Local Ethics Committee of the Sechenov First Moscow State Medical University (Sechenov University, Protocol No. 01-21 dated January 22, 2021.
Patient Consent for Publication: All patients provided informed consent for the publication of their data.
Authors’ Data Sharing Statement: The data supporting the findings of this study are available upon request from the corresponding author after approval from the principal investigator.
Acknowledgments: The authors express their sincere gratitude to the patients who participated in the study. 
Additional Information: The publication of the article is carried out within the framework of the dissertation work: «Markers of the stress system activation in assessing the adequacy of insulin therapy in type 1 diabetes mellitus».

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About the Authors

Regina A. Karamullina, Department of Endocrinology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; Karamullina.regina@mail.ru, ORCID: https://orcid.org/0000-0002-6813-5935, SPIN: 3505-6021 (corresponding author)
Sevindzh M. Ismailova, Department of Endocrinology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; seva.is99@mail.ru, ORCID: https://orcid.org/0000-0002-1809-7977
Ekaterina D. Lutoshkina, Department of Endocrinology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; ekaterinapesheva.endo@gmail.com, ORCID: https://orcid.org/0000-0002-1809-7977,SPIN-code 1833-6574
Irina V. Poluboyarinova, Cand. Sci. (Med.), Department of Endocrinology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; polub-irina@mail.ru, ORCID: https://orcid.org/0000-0003-2147-3061, SPIN: 2571-2900
Mikhail G. Poluektov, Cand. Sci. (Med.), Associate Professor, Department of Endocrinology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; polouekt@mail.ru, ORCID: https://orcid.org/0000-0001-6215-0918; SPIN: 7539-9525
Valentin V. Fadeev, Dr. Sci. (Med.), Professor, Corresponding Member of the Russian Academy of Sciences, Department of Endocrinology No. 1,
N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; walfad@mail.ru, ORCID: https://orcid.org/0000-0002-3026-6315, SPIN-code: 6825-8417

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