Opinion Former Article

Diabetes UK: Sleeping badly increases risk of eye disease in people with diabetes

People with Type 2 diabetes who have trouble sleeping are more at risk of eye disease, foot problems and amputation according to two new studies.

Researchers from the University of Birmingham1 looked at 231 people with Type 2 diabetes of whom 149 had obstructive sleep apnoea (OSA)2, a sleep disorder caused by disturbed breathing. They found there were twice as many people (48 per cent) with eye damage (severe retinopathy3) in the group with OSA compared to the group without OSA (20 per cent). Retinopathy is the leading cause of blindness in the UK's working-age population.

In a separate study4, researchers found that OSA was also linked to nerve damage (neuropathy5), which in extreme cases can lead to amputation. They looked at 230 people with Type 2 diabetes of whom 148 had OSA. They found that 60 per cent of the group with OSA had nerve damage compared to 22 per cent in the group without OSA.

Dr Iain Frame, Director of Research at Diabetes UK, said: "It's not new to say that many people with Type 2 diabetes have this sleeping disorder, but it is the first time we've seen researchers look at a link between this sleeping problem and damage to eyes and nerves suffered by some people with Type 2 diabetes. It seems that people with Type 2 diabetes could be more at risk of those complications if they have trouble sleeping than if they don't.

"A common theme between this sleeping disorder and Type 2 diabetes is being overweight, and both can be helped by sticking to the mantra of five fruit and vegetables a day, losing a bit of weight and being more physically active."

In both studies, the link between OSA and the two diabetes complications in people with Type 2 diabetes was independent of age, gender, ethnicity, blood pressure, blood glucose levels, smoking and cholesterol.

Dr Abd Tahrani, who led the research, said: "Our work highlights several important issues. Our results emphasised what is already known - that OSA is very common in patients with Type 2 diabetes, much higher than OSA prevalence in the general population. Furthermore, our results suggest that OSA is not an innocent bystander in patients with Type 2 diabetes and might contribute to morbidities associated with this condition. Whether OSA treatment has any impact on these complications will need to be determined"

There are around 3.3 millionpeople with Type 2 diabetes in the UK including an estimated 850,000 people who have the condition and are not aware of it.

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Notes to editor:

1. Obstructive sleep apnoea and sight threatening retinopathy: A novel association in patients with Type 2 diabetes A A Tahrani1,2, A Ali3, S Begum3, P Galsworthy2,4, H Wharton2,4, D Banerjee3, S Taheri1,2, A H Barnett1,2, M J Stevens1,2, P M Dodson2,4 1Centre of Endocrinology, Diabetes and Metabolism, University of Birmingham, Birmingham, UK 2Department of Diabetes and Endocrinology, Birmingham Heartlands Hospital, Birmingham, UK 3The Biomedical Unit, Birmingham Heartlands Hospital, Birmingham, UK 4Heart of England Diabetic Retinopathy Screening Centre of Excellence, Birmingham Heartlands Hospital, Birmingham, UK. P158, Diabetic Medicine: Abstracts of the Diabetes UK Annual Professional Conference (30 March to 1 April 2011), Volume 28, supplement 1. Published by Wiley-Blackwell. Both studies were presented at the Diabetes UK Annual Professional Conference 2011.

2. Obstructive sleep apnoea(OSA) is a condition that causes interrupted breathing during sleep. The onset of OSA is most common in people aged 35 to 54 years old, although it can affect people of all ages, including children. The condition often goes undiagnosed. Only one in four people with obstructive sleep apnoea are diagnosed with the condition. In the UK, it is estimated that around four in 100 middle-aged men and two in 100 middle-aged women have OSA.

3. People with diabetes are at risk of developing a complication called retinopathy. Retinopathy affects the blood vessels supplying the retina - the seeing part of the eye. Blood vessels in the retina of the eye can become blocked, leaky or grow haphazardly. This damage gets in the way of the light passing through to the retina and if left untreated can damage vision

4. Obstructive sleep apnoea is independently associated with peripheral neuropathy in patients with Type 2 diabetes A Tahrani1,2, A Ali3, S Begum3, K Dubb1, S Mughal3, M Piya1,2, B Jose3, D Banerjee3, S Taheri1,2, AH Barnett1,2, MJ Stevens1,2. P114, Diabetic Medicine: Abstracts of the Diabetes UK Annual Professional Conference (30 March to 1 April 2011), Volume 28, supplement 1. Published by Wiley-Blackwell.

5. Neuropathy is nerve damage and a long term complication of diabetes.Neuropathy can lead to foot ulcers and slow-healing wounds which, if they become infected, can result in amputation.

6. Diabetes UK is the leading charity for over 3.5 million people in the UK with diabetes In 2011, Diabetes UK aims to spend over £6 million on diabetes research to investigate the causes and prevention of diabetes, to improve care and treatment of diabetes and ultimately to work towards a cure. For more information visit www.diabetes.org.uk. In the UK, there are currently 2.8 million people diagnosed with diabetes and it is estimated that 850,000 people have Type 2 diabetes but do not know it.

7. Type 2 diabetesdevelops when the body can still make some insulin, but not enough, or when the insulin that is produced does not work properly (known as insulin resistance). Insulin acts as a key unlocking the cells, so if there is not enough insulin, or it is not working properly, the cells are only partially unlocked (or not at all) and glucose builds up in the blood. Type 2 diabetes accounts for between 85 and 95 per cent of all people with diabetes, usually affects people over 40 (over 25 in people from South Asian and Black backgrounds) and is treated with a healthy diet and increased physical activity. In addition to this, medication and/or insulin is often required. In most cases the condition is linked with being overweight and can go undetected for up to ten years meaning around 50 per cent of people show signs of complications by the time they are diagnosed.

8. Type 1 diabetesdevelops when insulin-producing cells in the pancreas are destroyed. This type of diabetes usually appears before the age of 40 and is the least common of the two main types and accounts for around 10 per cent of all people with diabetes. Type 1 diabetes cannot be prevented, it is not known why it develops and it is not connected with being overweight. People with Type 1 diabetes have to take insulin either via a pump or by injections several times a day to stay alive.

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