Sleep Duration, Energy Balance, and Risk of Diabetes

Study Questions:

Does sleep duration influence energy balance and risk of type 2 diabetes?


Data from the Nurses’ Health Study were used for the present analysis. Women with diabetes as of 2000 were excluded. Sleep duration was self-report; change in duration was defined as the difference in duration between the self-report in 1986 and 2000. Additional factors including physical activity and diet were collected every 2-4 years. The primary outcome of interest was development of diabetes.


A total of 59,031 women, ages 55-83 years as of 2000, were included. During the follow-up (up to 2012), 3,513 new cases of diabetes were observed. Most women reported similar sleep duration between 1896 and 2000, and almost half reported a duration of 7-8 hours per night. Decreases in sleep were associated with lower diet quality and less physical activity compared to no change in sleep duration. Increases in sleep duration were associated with weight gain compared to no change over time. The hazard ratio for development of diabetes for ≤−2, >−2 to <0, >0 to <2, and ≥2 hours/day change in sleep duration were hazard ratio (HR), 1.09 (95% confidence interval [CI], 0.93-1.28), 1.10 (95% CI, 1.001-1.12), 1.09 (95% CI, 1.00-1.18), and 1.30 (95% CI, 1.14-1.46), using no change in sleep as a reference group and after adjustment for multiple potential confounders. Additional adjustment for diet and physical activity did not appreciably alter the results. Increases in sleep duration ≥2 hours/day remained adversely associated with diabetes (HR, 1.15 [95% CI, 1.01-1.30]) after adjustment for change in covariates, including body mass index.


The investigators concluded that duration of sleep was associated with risk for diabetes among middle-aged or older women.


These data suggest that most middle-aged to elderly women sleep an adequate duration per night. However, among those with shortened duration or excessive sleep duration, risk for diabetes mellitus or weight gain is increased. Factors associated with changes in sleep, including depression, may account for some of the association observed.

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Diet, Exercise

Keywords: Diabetes Mellitus, Type 2, Sleep Disorders, Body Mass Index, Diet, Disorders of Excessive Somnolence, Exercise, Metabolic Syndrome X, Motor Activity, Risk, Secondary Prevention, Weight Gain

< Back to Listings