Combined sleep behaviors, mediating biomarkers, and incident vascular complications among individuals with type 2 diabetes: A prospective study in UK Biobank.

Authors

Yanqiu Zou, Xia Jiang, Jinyu Zhou, Tao Han, Sirui Zheng, Mingshuang Tang, Yutong Wang, Lin Chen, Lingli Qiu, Xuan Wu, Zhixin Tan, Yunjie Liu, Bowen Lei, Xiaofeng Ma, Di Zhang, Jiaqiang Liao, Jiayuan Li, Ben Zhang, Mengyu Fan

Published in

Journal of diabetes investigation. Jul 22, 2026. Epub Jul 22, 2026.

Abstract

To prospectively examine how combined sleep behaviors affect vascular complications in type 2 diabetes, whether these associations are modified by disease severity, as well as the mediating roles of clinical biomarkers.
A total of 12,456 participants with type 2 diabetes from the UK Biobank were included. A sleep score was defined by: sleep duration, chronotype, insomnia, snoring, and daytime sleepiness. Cox regression models were used to examine the association between healthy sleep score and risk of vascular complications.
Over 13.5 years, 1,878 macrovascular and 3,066 microvascular complications occurred. Compared with a healthy sleep score of 0-1, the multivariable-adjusted HRs (95% CIs) of the score 4-5 were 0.75 (0.63, 0.89) for macrovascular complications [coronary artery disease 0.72 (0.57, 0.91), stroke 0.92 (0.66, 1.28), peripheral artery disease 0.79 (0.56, 1.10)]; 0.86 (0.75, 0.99) for microvascular complications [neuropathy 0.62 (0.47, 0.83), nephropathy 1.01 (0.84, 1.21), retinopathy 0.84 (0.68, 1.03)]. The aggregated diabetes severity score (P_interaction = 0.037) significantly modified the association with microvascular complications. Total cholesterol, LDL-C, triglycerides, apolipoprotein B, and CRP collectively explained 11.34% (4.24%, 37.70%) of macrovascular associations [including 11.14% (2.85%, 43.03%) for coronary artery disease], while total bilirubin explained 3.57% (0.43%, 20.63%) of microvascular associations, collectively with triglycerides, GGT, and CRP mediating 9.33% (3.95%, 27.58%) for diabetic neuropathy.
A healthy sleep pattern is associated with lower risks of vascular complications in type 2 diabetes, independent of traditional risk factors, and the association with microvascular complications is modified by diabetes severity. Lipid profiles and inflammatory factors partly mediate the favorable association.

PMID:
42484390
Bibliographic data and abstract were imported from PubMed on 22 Jul 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.