Modifiable self-management practices impact nocturnal and morning glycaemia in type 1 diabetes.

Aims: To identify risk factors for nocturnal/morning hypo- and hyperglycaemia in type 1 diabetes.
Methods: Data on self-management practices were obtained from 3-day records. We studied the associations between self-management practices on the first recording day and the self-reported blood glucose (BG) concentrations on the subsequent night/morning.
Results: Of the 1025 participants (39 % men, median age 45 years), 4.4 % reported nocturnal hypoglycaemia (<3.9 mmol/l), 9.8 % morning hypoglycaemia, 51.5 % morning euglycaemia, and 34.3 % morning hyperglycaemia (≥8.9 mmol/l). Within hypoglycaemic range, insulin pump use was associated with higher nocturnal BG concentration (B=0.486 [95 % Confidence Interval=0.121-0.852], p=0.009). HbA _1c was positively (0.046 [0.028-0.065], p<0.001), while antecedent fibre intake (-0.327 [-0.543 - -0.111], p=0.003) and physical activity (PA) (-0.042 [-0.075 - -0.010], p=0.010) were inversely associated with morning BG concentration. The odds of morning hypoglycaemia were increased by previous day hypoglycaemia (OR=2.058, p=0.002) and alcohol intake (1.031, p=0.001). Previous day PA (0.977, p=0.031) and fibre intake (0.848, p=0.017) were inversely, while HbA _1c (1.027, p<0.001) was positively associated with the risk of morning hyperglycaemia.
Conclusions: Alcohol avoidance may prevent nocturnal hypoglycaemia, while PA and fibre intake may reduce hyperglycaemia risk. Avoidance of daytime hypoglycaemia and keeping HbA _1c in control may help maintain normoglycaemia also at night-time.
Competing Interests: Declaration of Competing Interest Professor Per-Henrik Groop has received investigator-initiated grants from Eli Lilly and Roche, is an advisory board member for AbbVie, Astellas, Astra Zeneca, Bayer, Boehringer-Ingelheim, Eli Lilly, Janssen, Medscape, MSD, Mundipharma, Nestlé, Novartis, Novo Nordisk, and Sanofi. He has received lecture honoraria from Astellas, Astra Zeneca, Bayer, Boehringer Ingelheim, Eli Lilly, Elo Water, Genzyme, Medscape, MSD, Mundipharma, Novartis, Novo Nordisk, PeerVoice, Sanofi and Sciarc. Erika Parente has received lecture honoraria from Eli Lilly, Abbott, Astra Zeneca, Sanofi, and Boehringer Ingelheim. The other authors declare no conflicts of interest.
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