Factors Associated with Lifestyle Behaviors among University Students-A Cross-Sectional Study.

Lifestyle behaviors are daily habits influenced by social and environmental factors. This study examined lifestyle behaviors and their associations with sociodemographics, comorbidities, and pain in Saudi university students during the academic year 2021 and 2022. All students received the study invitation via university emails to complete an online questionnaire. The questionnaire included four sections (sociodemographics, health-related information, desired health promotion activities, and a lifestyle behavior assessment) via Health-Promoting Lifestyle Profile II (HPLP-II). The associations between study variables were assessed using Pearson's correlation and multiple linear regression. The study questionnaire was completed by 1112 students. No correlation was found between sociodemographics and lifestyle-behavior-related factors except for students in the College of Science who appeared to have good lifestyle behaviors (an increase in HPLP II total scores of 3.69). Students with mental health issues have poorer lifestyle behaviors and spend more time sitting (p < 0.00). Students without disabilities have lower scores in health responsibility, physical activity, nutrition, and stress management, while auditory disability specifically lowers health responsibility (p < 0.00). Pain was not associated with any assessed lifestyle behaviors. This study identified several significant correlations and differences between variables such as age, sedentary behavior, sleep duration, disability status, college major, and lifestyle behaviors among PNU students. These findings provide insights into the factors that influence students' health-promoting behaviors and can help guide interventions for promoting healthier lifestyles on campus. Targeted health promotion strategies at an early age could help in decreasing overall noncommunicable disease incidents later in life. The study results should be interpreted taking into consideration that the collected data were cross-sectional and self-reported. In conclusion, the findings of this study clearly demonstrate the need for specific lifestyle and health-promoting programs that are directed toward university students.

Comprehensive assessment of physical activity policies and initiatives in Saudi Arabia 2016-2022.

Objective: This study aimed to review health-enhancing physical activity (HEPA) policies and initiatives introduced in Saudi Arabia (SA) since 2016 and identify the gaps in their design and implementation. Methods: A combination of methods was used, including semi-structured interviews with key informants from relevant entities (such as those from the ministries of health, education, sports, tourism, and other regulatory bodies) and a review of policy/initiative documents provided by them. Stakeholder mapping led by local experts and snowball sampling supported the identification of key informants. Three existing frameworks-the World Health Organization's HEPA Policy Audit Tool, the Global Observatory for Physical Activity (PA) Policy Inventory, and the European Monitoring Framework for PA Indicators-were used to develop data collection instruments. Results: The review identified 44 policies/initiatives from different sectors. The Saudi Sports for All Federation is the leader in PA promotion and community sports development. However, there is a lack of multisectoral agenda and governance structures for PA promotion. The overlap between initiatives by different key informants results in duplication of efforts, including initiatives to promote PA among the general public led by competitive professional sports and community-based sports. Conclusion: The study findings indicate that several policies/initiatives have been implemented in SA since 2016. However, there is a need to focus on the challenges or barriers that affect the sustainability of policies/initiatives. A system-based approach can help build on sectoral synergies, thereby accelerating progress in engaging the Saudi population with PA.

Prevalence of lower back pain and its associations with lifestyle behaviors among college students in Saudi Arabia.

BACKGROUND: Lower back pain (LBP) is a common musculoskeletal disorder that may affect students' daily lives. Recent psychological research showed a relevant connection between LBP and multidimensional health. However, the association between LBP and lifestyle behavior has not been established, and improving knowledge in this area may help develop preventive strategies and optimize college students' quality of life. METHODS: A cross-sectional study of 1420 college students in Saudi Arabia was conducted, and participants who attended Saudi Universities were recruited from May 2021 to November 2021. An established validated online survey assessed LBP, sleep quality, time spent sedentary (sedentary duration), health responsibility, physical activity, nutrition, spiritual growth, interpersonal relationships, and stress management. Generalized Linear Regression was used to assess the associations between LBP severity and lifestyle behaviors after controlling for covariates. RESULTS: LBP was prevalent among college students from Saudi Arabia. Most of the sample were young (23.81 ± 6.02), and female (83.7%). There were significant differences between students with and without LBP regarding age, BMI, sex, marital status, pain severity, overall lifestyle behavior, health responsibility, physical activity, nutrition, stress management, and global sleep quality. After controlling for age, BMI, sex, and marital status, there were significant associations between pain severity and global sleep quality (ß=0.2, p < .001, CI: 16 to 0.24), and sedentary duration (ß=0.03, p = .01, CI:0.009 to 0.06). CONCLUSIONS: This study helped define the prevalence of LBP in college students in Saudi Arabia and evaluated the association between LBP and lifestyle behaviors. The findings showed that students with higher levels of poor sleep quality or sedentary behavior had higher levels of pain. Promoting sleep quality and reducing sedentary behavior may help establish preventive strategies for LBP in college students.

Arabic translation and cultural adaptation of sedentary behavior, dietary habits, and preclinical mobility limitation questionnaires: A cognitive interview study.

BACKGROUND: Developing global evidence on the influence of health-related behaviors (e.g., sedentary behavior, diet) and mobility limitations on health requires global consortia from diverse sets of countries. Thus, the purpose was to translate and culturally adapt (i) the Sedentary Behavior Questionnaire (SBQ); (ii) the Dietary Habits Questionnaire adapted from the Survey of Health, Aging and Retirement in Europe (SHARE) study; (iii) the Preclinical Mobility Limitation questionnaire for use in the Saudi Arabian context. METHOD: 50 adult Saudi participants (mean age 41.7±9.6, 48% female) participated in this study. We followed a systematic cross-cultural adaptation process that involved forward translation, synthesis, back-translation, expert panel, and pre-testing (cognitive interviewing). Four rounds of cognitive interviews were held with 40 participants for the SBQ, SHARE questionnaire, and the Preclinical Mobility Limitation questionnaire, an additional round was needed for the Preclinical Mobility Limitation questionnaire. Descriptive data (means ± standard deviations and frequencies with percentages) were reported for characteristics. RESULT: With some minor changes to the questionnaires, the SBQ, Dietary Habits, and Preclinical Mobility Limitation questionnaires were translated and cross-culturally adapted into Arabic. 100% of the participants confirmed that the resulting Arabic versions of the SBQ, Dietary Habits questionnaire, and Preclinical Mobility Limitation questionnaires were appropriate and fully understandable for Arabic speakers in communicating the intended meanings of the items in each. For example, item SBQ1, 'Watching television (including videos on VCR/DVD)' was changed to 'Sitting and watching television or videos (including smartphones, tablets)'. CONCLUSION: The SBQ, Dietary Habits questionnaire, and Preclinical Mobility Limitation questionnaire were successfully cross-culturally adapted into Arabic and are now ready for use in Saudi Arabian.

A scoping review on the impact of the COVID-19 pandemic on physical activity and sedentary behavior in Saudi Arabia.

BACKGROUND: In Saudi Arabia, stay-at-home orders to address the coronavirus disease 2019 (COVID-19) pandemic between March 15 and 23, 2020 and eased on May 28, 2020. We conducted a scoping review to systematically describe physical activity and sedentary behavior in Saudi Arabia associated with the timing of the lockdown. METHODS: We searched six databases on December 13, 2021 for articles published in English or Arabic from 2018 to the search date. Studies must have reported data from Saudi Arabia for any age and measured physical activity or sedentary behavior. RESULTS: Overall, 286 records were found; after excluding duplicates, 209 records were screened, and 19 studies were included in the review. Overall, 15 studies were cross-sectional, and 4 studies were prospective cohorts. Three studies included children and adolescents (age: 2-18 years), and 16 studies included adults (age: 15-99 years). Data collection periods were < = 5 months, with 17 studies collecting data in 2020 only, one study in 2020-2021, and one study in 2021. The median analytic sample size was 363 (interquartile range 262-640). Three studies of children/adolescents collected behaviors online at one time using parental reporting, with one also allowing self-reporting. All three studies found that physical activity was lower during and/or following the lockdown than before the lockdown. Two studies found screen time, television watching, and playing video games were higher during or following the lockdown than before the lockdown. Sixteen adult studies assessed physical activity, with 15 utilizing self-reporting and one using accelerometry. Physical activity, exercise, walking, and park visits were all lower during or following the lockdown than before the lockdown. Six adult studies assessed sedentary behavior using self-report. Sitting time (4 studies) and screen time (2 studies) were higher during or following the lockdown than before the lockdown. CONCLUSIONS: Among children, adolescents, and adults, studies consistently indicated that in the short-term, physical activity decreased and sedentary behavior increased in conjunction with the movement restrictions. Given the widespread impact of the pandemic on other health behaviors, it would be important to continue tracking behaviors post-lockdown and identify subpopulations that may not have returned to their physical activity and sedentary behavior to pre-pandemic levels to focus on intervention efforts.

Prevalence of sarcopenia among Saudis and its association with lifestyle behaviors: Protocol for cross-sectional study.

BACKGROUND: Sarcopenia is an age-related muscular disease manifesting as a loss of muscle function and mass-leads to detrimental consequences at both individual and community levels. Modifiable lifestyle factors (such as physical behaviors and nutritional habits) may be involved in sarcopenia etiology. European Working Group on Sarcopenia in Older Population (EWGOSP2) established a cut-off point for sarcopenia diagnosis based on the European population and they recommend the use of a regional normative population. However, no sufficient data on sarcopenia prevalence is presently available in Saudi Arabia. Therefore, this project aims to define appropriate reference values from healthy Saudi young adults (Phase I) and to investigate the prevalence of sarcopenia in Saudi Arabia (Phase II) and examine selected modifiable lifestyle correlates of sarcopenia (Phase I, II). METHODS: The project will involve two phases. Phase I will include 1532 healthy Saudi young adults aged between 20-40 years. While, Phase II will include 1532 Saudi older adults aged ≥50 years. The study will measure vital signs, anthropometrics, muscle mass using bioelectrical impedance analysis and dual-energy X-ray absorptiometry, muscle strength using handgrip strength and maximal isometric strength, physical function using short physical performance battery, and 6-minute walk test to measure aerobic endurance. To explore the associations between lifestyle behaviors with sarcopenia indices, physical activity, sedentary behaviour and sleep will be evaluated subjectively using Global Physical Activity Questionnaire and Pittsburgh Sleep Quality Index and objectively via ActivPAL accelerometers. A three-day dietary food record will also be used to evaluate dietary intake. Additionally, EuroQOL five-dimension questionnaire will be utilized to assess health-related quality of life. DISCUSSION: The study will have significant implications in recognizing the prevalence of sarcopenia in Saudi population, which will guide our future interventional studies aimed at early prevention and treatment of this disease.

An Arabic Sedentary Behaviors Questionnaire (ASBQ): Development, Content Validation, and Pre-Testing Findings.

BACKGROUND: Sedentary behaviors (SB) are very prevalent nowadays. Prolonged sitting associates with chronic disease risks and increased mortality even while controlling for physical activity. Objective measurement of SB is costly, requires technical expertise, and is challenging in terms of time and management. Currently, there is no validated self-reported instrument in the Arabic language that assesses SB among individuals and relates sedentary time to social, environmental, and health outcomes. The aim of this research was to develop a multi-item Arabic SB questionnaire (ASBQ). METHODS: The ASBQ was developed through an extensive literature review and discussion by the research team (n = 5), then went through content validation (n = 10 experts) and pre-testing using cognitive interviewing procedures (n = 51 respondents, mean (SD) age was 38.3 (18.2) years, and with 49% females). RESULTS: The ASBQ included 13 questions comprising a wide range of sedentary activities. The Arabic SB instrument showed excellent content validity for assessing sedentary time in adolescents and adults with a very high item-level and scale-level content validity index. A kappa statistic, a measure of interrater reliability, was 0.95. The pre-testing showed that the instrument was highly rated by a diverse sample of Saudi adolescents and adults. CONCLUSION: The ASBQ received excellent acceptance by a panel of experts with promising pre-test results. Further testing of psychometric properties, including test-retest reliability and criterion validity is required.

Investigating the current environmental situation in the Middle East and North Africa (MENA) region during the third wave of COVID-19 pandemic: urban vs. rural context.

BACKGROUND: Coronavirus 2019 (COVID-19) pandemic led to a massive global socio-economic tragedy that has impacted the ecosystem. This paper aims to contextualize urban and rural environmental situations during the COVID-19 pandemic in the Middle East and North Africa (MENA) Region. RESULTS: An online survey was conducted, 6770 participants were included in the final analysis, and 64% were females. The majority of the participants were urban citizens (74%). Over 50% of the urban residents significantly (p < 0.001) reported a reduction in noise, gathering in tourist areas, and gathering in malls and restaurants. Concerning the pollutants, most urban and rural areas have reported an increase in masks thrown in streets (69.49% vs. 73.22%, resp.; p = 0.003). Plastic bags and hospital waste also increased significantly with the same p-value of < 0.001 in urban areas compared with rural ones. The multifactorial logistic model for urban resident predictors achieved acceptable discrimination (AUROC = 0.633) according to age, crowdedness, noise and few pollutants. CONCLUSION: The COVID-19 pandemic had a beneficial impact on the environment and at the same time, various challenges regarding plastic and medical wastes are rising which requires environmental interventions.

Virtual Behavioral Intervention to Promote Healthy Lifestyle Behaviors: A Feasibility RCT during COVID-19 Pandemic.

BACKGROUND: the COVID-19 pandemic has had a substantial impact on human health, affecting many lifestyle behaviors such as physical activity, sedentary behavior, dietary habits and sleep. PURPOSE: to assess the feasibility of six sessions of a virtual behavioral intervention to promote healthy lifestyle practices during a stay-at-home advisory phase of the COVID-19 pandemic. METHODS: A participant-blinded randomized controlled trial was performed through a virtual platform setting. Participants were randomly assigned into two groups. They were assigned to a motivational interviewing (MI) intervention or attention group, with pre- and postintervention assessments. The MI treatment consisted of six sessions (twice each week). The same number of virtual structured sessions were provided for the attention group, and they provided brief advice to promote healthy lifestyles. The study was conducted from April to June 2020. RESULTS: The feasibility outcomes indicated that 39 of the 50 participants (78%) completed the trial. The dropout rate was 21.7% for the attention group and 22.2% for the intervention group. Participating in MI had a significant positive interventional effect on physical activity level, distress and fear of COVID-19. CONCLUSIONS: It is feasible to deliver behavioral change interventions virtually. Further, MI can be used as a useful strategy for the favorable promotion of a healthy lifestyle. TRIAL REGISTRATION: NCT05392218 (26/05/2022).

Sedentary Behavior Counseling Intervention in Aging People With Type 2 Diabetes: A Feasibility Study.

This study examined the feasibility and effect of sedentary behavior (SB) counseling on total sitting time (TST) and glycemic control in people with type 2 diabetes (T2D). Community-dwelling sedentary adults with T2D (n = 10; 8 women; age 65.6 ± 7.31) completed SB counseling (motivational interviewing-informed education about SB) aided by an activity monitor with a vibrotactile feature (activPAL3TM). The monitor was worn for 7 days, on weeks 1 and 13 (without the vibrotactile feature) and during weeks 5 and 9 (with the vibrotactile feature). Intervention feasibility was determined by study retention rates and activity monitor tolerability, and differences between pre- and post-intervention average daily TST. Paired t-test were performed. The effect size (ES) was calculated using Cohen d. All participants attended all study sessions with only 20% reporting moderate issues tolerating the activity monitor. TST time decreased from 11.8 hours ± 1.76 at baseline to 10.29 hours ± 1.84 at 3 months' assessment (P < .05) with a large ES (Cohen d = .88). HbA1c was decreased by 0.51% (P < .05) at the end of the intervention. This study found that the intervention was feasible for sedentary adults with type 2 diabetes.

Lifestyle behaviors trend and their relationship with fear level of COVID-19: Cross-sectional study in Saudi Arabia.

INTRODUCTION: COVID-19 pandemic cautionary measures have affected the daily life of people around the globe. Further, understanding the complete lifestyle behaviors profile can help healthcare providers in designing effective interventions and assessing overall health impact on risk of disease development. Thus, this study aims to assess the complete spectrum of lifestyle behaviors (physical activity, sedentary behavior, sleep, distress, social support, dietary habits, and smoking) prevalence and its association with fear of COVID-19 in people living in Saudi Arabia. METHODS: Self-administered survey consisted of seven sections was used to collect data on fear of COVID-19 using Fear of COVID-19 Scale (FCV-19S), physical activity and sedentary behavior using the Global Physical Activity Questionnaire (GPAQ), sleep quality using the Pittsburgh Sleep Quality Index (PSQI), psychosocial distress using Kessler Psychological Distress Scale (K-10), social support using the MOS social support survey, and dietary habits using a short version of food frequency questionnaire (FFQ). The online survey was distributed via social media platforms during lockdown period of COVID-19 pandemic (May-June 2020). Each section consisted of validated questionnaire examining one of aforementioned lifestyle behaviors. Associations were analyzed using multiple linear regression. RESULTS: A total of 669 individuals attempted to complete the online survey, 554 participants completed at least 2 sections of the survey (82.8%), and 41.3% (n = 276) completed the whole online survey. The majority of the sample were female (83%), not smokers (86.5%), had sufficient sleep duration (7.5 hrs ± 2.1), and only indicated mild level of distress (21.4 ± 8.9); they also reported high level of sedentary behavior (7.7 hrs ± 4.5), poor sleep quality (5.4 ± 2.4), were not engaged in healthy eating habits, and moderate level of perceived social support (62.0% ± 27). Only physical activity results indicated that about half of the sample were engaged in moderate to vigorous level of physical activity (54.3%). Further, being female (ß = 0.12; 95% CI: 0.45, 2.94) and married (ß = 0.13; 95% CI: 0.3, 2.63) were associated with fear of COVID-19 level (ß = 0.21; 95% IC: 0.05, 0.19) with a confidence interval level of 95%. In addition, distress was associated with fear. CONCLUSION: The trend of lifestyle behaviors measured during lockdown period changed from previously published rates. Future research needs to establish the short-term and long-term effect of lifestyle behaviors complete profile on physical and mental health.

Joint consensus statement of the Saudi Public Health Authority on the recommended amount of physical activity, sedentary behavior, and sleep duration for healthy Saudis: Background, methodology, and discussion.

The Saudi Public Health Authority recently prepared a Consensus Statement regarding how much time a person should spend engaged in physical activity, sedentary behavior, and sleep to promote optimal health across all age groups. This paper describes the background literature, methodology, and modified RAND Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT approach that guided the development process. A Leadership Group and Consensus Panels were formed, and credible existing guidelines were identified. The Panel identified clear criteria to choose the best practice guidelines for the set objectives after evaluation, based on GRADE table evidence, findings table summaries, and draft recommendations. Updating of the selected practice guidelines was performed, and the Consensus Panels separately reviewed the evidence for each behavior and decided to adopt or adapt the selected practice guideline recommendations or create de novo recommendations. Data related to cultural factors that may affect the studied behaviors, such as prayer times, midday napping or "Qailulah," and the holy month of Ramadan, were also reviewed. Two rounds of voting were conducted to reach a consensus for each behavior.

The recommended amount of physical activity, sedentary behavior, and sleep duration for healthy Saudis: A joint consensus statement of the Saudi Public Health Authority.

BACKGROUND: The goal of the 24-h Movement Practice Guidelines for Saudi Arabia is to provide policymakers, health-care providers, researchers, sports professionals, and members of the public with recommendations on the duration of time they should spend engaged in physical activity, sedentary behavior, and sleep throughout all age groups. METHODS: A modified RAND appropriateness method and the "GRADE-ADOLOPMENT" approach of guideline recommendations were used by a guideline development panel to develop the present recommendations. RESULTS: The recommendations were based on the integrated needs of the following age groups: children (0-2 years), preschoolers (3-5 years), children and adolescents (6-17 years), adults (18-64 years), and older adults (≥65 years). The guidelines also include special considerations for sleep duration in the Saudi culture, such as dawn prayer and Ramadan. CONCLUSIONS: Several research gaps in physical activity, sedentary behavior, and sleep were identified and highlighted by the guideline development panel for potential future research.

Anthropometric Measurements, Sociodemographics, and Lifestyle Behaviors among Saudi Adolescents Living in Riyadh Relative to Sex and Activity Energy Expenditure: Findings from the Arab Teens Lifestyle Study 2 (ATLS-2).

The aim of the study was to examine the anthropometric measurements, sociodemographics, and lifestyle behaviors among Saudi adolescents relative to sex and physical activity (PA). A random cross-sectional survey conducted on Saudi adolescents from secondary schools in Riyadh, using a multistage stratified cluster sampling technique. Measurements included demographics, weight, height, waist circumference, PA, sedentary behaviors (SB), sleep duration, and dietary habits using a validated questionnaire. A total of 1262 adolescents (16.4 ± 0.95 years; 52.4% males) were studied. Overweight/obesity was more than 40%. Physical inactivity among adolescents was 53%, which indicates some improvement over the past years, especially among females. More than 80% of adolescents had over three hours/day of screen time, with no significant sex differences. Insufficient sleep was highly prevalent with gender differences. A large proportion of the participants did not consume daily breakfast (65.7%), vegetables (73.2%), fruits (84.2%), or milk/dairy products (62.4%), whereas significant proportions of the adolescents consumed sugar-sweetened drinks, fast food, French fries/potato chips, cake/donuts, and chocolates/candy on at least three days or more per week. It was concluded that non-daily intake of breakfast and vegetables was significantly associated with lower PA. The updated information can aid in effectively planning and implementing promotional programs toward improving the lifestyle behaviors of Saudi adolescent.

Using Cognitive Behavioral Therapy for Insomnia in People with Type 2 Diabetes, Pilot RCT Part I: Sleep and Concomitant Symptom.

OBJECTIVE/BACKGROUND: The primary aim of this study was to examine the effect of Cognitive Behavioral Therapy for Insomnia (CBT-I) on the severity of insomnia in people with Type 2 diabetes (T2D) compared to a health education (HE) control group. The secondary aim was to explore the effect of CBT-I on other sleep outcomes and concomitant symptoms. PARTICIPANTS: Twenty-eight participants with T2D were randomly assigned to CBT-I (n = 14) or HE (n = 14). METHODS: Validated assessments were used at baseline and post intervention to assess sleep outcomes and concomitant symptoms. In addition, actigraph and sleep diaries were used to measure sleep parameters. Independent sample t tests and Mann-Whitney U tests were utilized to measure between-group differences in the mean change scores. RESULTS: Participants in the CBT-I group showed higher improvements in the following mean change scores compared to the HE group: insomnia symptoms (d = 1.78; p < .001), sleep quality (d = 1.53; p =.001), sleep self-efficacy (d = 1.67; p < .001). Both actigraph and sleep diary showed improvements in sleep latency and sleep efficiency in the CBT-I group as compared to the HE group. In addition, participants in the CBT-I group showed greater improvement in the mean change scores of depression symptoms (d = 1.49; p = .002) and anxiety symptoms (d = 0.88; p = .04) compared to the HE group. CONCLUSION: This study identified a clinically meaningful effect of CBT-I on sleep outcomes and concomitant symptoms in people with T2D and insomnia symptoms. Further work is needed to investigate the long-term effects of CBT-I in people with T2D and insomnia symptoms.

Test-Retest Reliability of activPAL in Measuring Sedentary Behavior and Physical Activity in People With Type 2 Diabetes.

BACKGROUND: To investigate how changes in sedentary behavior relate to health outcomes, it is important to establish the test-retest reliability of activity monitors in measuring habitual sedentary behavior in people with type 2 diabetes (T2D) as a prerequisite for interpreting this information. Thus, the authors' objective was to examine the test-retest reliability of a common activity monitor (activPAL™) in measuring sedentary behavior and physical activity in people with T2D. METHODS: Sedentary-time, standing-time, stepping-time, step-count, and sit-to-stand transitions were obtained from two 7-day assessment periods separated by at least 1 week. Test-retest reliability was determined with the intraclass correlation coefficient (ICC) to compare sedentary and activity measures between the 2 time points. RESULTS: A total of 30 participants with self-reported T2D completed the study (age 65 [6] y, 63% women, body mass index 33.3 [5] kg/m2). High test-retest reliability was found for sedentary-time (ICC = .79; 95% confidence interval [CI], .61-.89) and standing-time (ICC = .74; 95% CI, .53-.87). Very high test-retest reliability was found for stepping-time (ICC = .90; 95% CI, .81-.95), step-count (ICC = .91; 95% CI, .83-.96), and sit-to-stand transitions (ICC = .90; 95% CI, .79-.95). CONCLUSION: The activPAL™ device showed high to very high test-retest reliability in measuring all tested activity categories in people with T2D.

The effects of cognitive behavioral therapy for insomnia in people with type 2 diabetes mellitus, pilot RCT part II: diabetes health outcomes.

BACKGROUND: Previous studies have shown the negative impact of sleep disturbances, specifically insomnia symptoms, on glucose metabolism for people with type 2 diabetes (T2D). People with insomnia symptoms are at risk of poor glycemic control and suboptimal diabetes self-care behavior (DSCB). Investigating the impact of a safe and effective intervention for individuals with T2D and insomnia symptoms on diabetes' health outcomes is needed. Therefore, the aim of this exploratory study is to examine the effects of Cognitive Behavioral Therapy for Insomnia (CBT-I) on glycemic control, DSCB, and fatigue. METHODS: Twenty-eight participants with T2D and insomnia symptoms, after passing an eligibility criteria at a medical research center, were randomly assigned to CBT-I (n = 14) or Health Education (HE; n = 14). The CBT-I and HE groups received 6 weekly one-hour sessions. This Randomized Controlled Trial (RCT) used a non-inferiority framework to test the effectiveness of CBT-I. Validated assessments were administered at baseline and post-intervention to assess glycemic control, DSCB, and fatigue. A Wilcoxon signed-rank test was utilized to compare within-group changes from baseline to post-intervention. A Mann-Whitney test was utilized to measure the between-group differences. Linear regression was used to assess the association between the blood glucose level and the number of days in the CBT-I group. RESULTS: The recruitment duration was from October 2018 to May 2019. A total of 13 participants completed the interventions in each group and are included in the final analysis. No adverse events, because of being a part of this RCT, were reported. CBT-I participants showed significantly greater improvement in glycemic control, DSCB, and fatigue. There was a significant association between the number of days in the CBT-I intervention with the blood glucose level before bedtime (B = -0.56, p = .009) and after awakening in the morning (B = -0.57, p = .007). CONCLUSIONS: This study demonstrated a clinically meaningful effect of CBT-I on glycemic control in people with T2D and insomnia symptoms. Also, CBT-I positively impacted daytime functioning, including DSCB and fatigue. Future research is needed to investigate the long-term effects of CBT-I on laboratory tests of glycemic control and to understand the underlying mechanisms of any improvements. TRIAL REGISTRATION: Clinical Trials Registry ( NCT03713996 ). Retrospectively registered on 22 October 2018.

The Association of Diabetes With Knee Pain Locations, Pain While Walking, and Walking Speed: Data From the Osteoarthritis Initiative.

OBJECTIVE: Osteoarthritis (OA) and diabetes mellitus (DM) often coexist and can result in negative outcomes. DM can affect pain and walking speed in people with knee OA; however, the impact of DM on OA is understudied. The purpose of this study was to investigate the association between diabetes and knee pain locations, pain severity while walking, and walking speed in people with knee OA. METHODS: A cross-sectional analysis was used. Data from 1790 individuals from the Osteoarthritis Initiative (mean [SD] age = 69 [8.7] years) with knee pain were included and grouped into knee OA and diabetes (n = 236) or knee OA only (n = 1554). Knee pain locations were categorized as no pain, localized pain, regional pain, or diffuse pain. Knee pain during a 20-m walk test was categorized as no pain, mild, moderate, or severe knee pain. Walking speed was measured using the 20-m walk test. Multinomial and linear regression analyses were performed. RESULTS: Diabetes was associated with regional knee pain (odds ratio [OR] = 1.77; 95% CI = 1.01-3.11). Diabetes was associated only with moderate (OR = 1.78; 95% CI = 1.02-3.10) or severe (OR = 2.52; 95% CI = 1.01-6.28) pain while walking. Diabetes was associated with decreased walking speed (B = -0.064; 95% CI = -0.09 to -0.03). CONCLUSIONS: Diabetes was associated with regional knee pain but not with localized or diffuse knee pain and was associated with moderate to severe knee pain while walking and slower walking speed in people with knee OA. IMPACT: Clinicians can use a knee pain map for examining knee pain locations for people with diabetes and knee OA. Knee pain during walking and walking speed should be screened for people with knee OA and diabetes because of the influence of diabetes on these parameters in this population. LAY SUMMARY: Diabetes might be associated with specific knee pain locations, pain during activities such as walking, and reduced walking speed in people with knee OA.

Sleep Efficiency and Total Sleep Time in Individuals with Type 2 Diabetes with and without Insomnia Symptoms.

There is increasing awareness of the high prevalence of insomnia symptoms in individuals with type 2 diabetes (T2D). Past studies have established the importance of measuring sleep parameters using measures of central tendency and variability. Additionally, subjective and objective methods involve different constructs due to the discrepancies between the two approaches. Therefore, this study is aimed at comparing the averages of sleep parameters in individuals with T2D with and without insomnia symptoms and comparing the variability of sleep parameters in these individuals. This study assessed the between-group differences in the averages and variability of sleep efficiency (SE) and total sleep time (TST) of 59 participants with T2D with and without insomnia symptoms. Actigraph measurements and sleep diaries were used to assess sleep parameter averages and variabilities calculated by the coefficient of variation across 7 nights. Mann-Whitney U tests were utilized to compare group differences in the outcomes. Validated instruments were used to assess the symptoms of depression, anxiety, and pain as covariates. Objective SE was found to be statistically lower on average (85.98 ± 4.29) and highly variable (5.88 ± 2.57) for patients with T2D and insomnia symptoms than in those with T2D only (90.23 ± 6.44 and 3.82 ± 2.05, respectively). The subjective average and variability of SE were also worse in patients with T2D and insomnia symptoms, with symptoms of depression, anxiety, and pain potentially playing a role in this difference. TST did not significantly differ between the groups on averages or in variability even after controlling for age and symptoms of depression, anxiety, and pain. Future studies are needed to investigate the underlying mechanisms of worse averages and variability of SE in individuals with T2D and insomnia symptoms. Additionally, prompting the associated risk factors of insomnia symptoms in individuals with T2D might be warranted.

Associations between ankle-brachial index, diabetes, and sleep apnea in the Hispanic community health study/study of Latinos (HCHS/SOL) database.

BACKGROUND: Sleep apnea and diabetes mellitus (DM) negatively impact cardiovascular health. One important indicator of cardiovascular health is the Ankle-Brachial Index (ABI). Either low ABI or high ABI are signs of peripheral vascular impairment. Impaired vascular health and DM, together, might provoke sleep apnea; however, information regarding these relationships is limited. Therefore, this study aimed to investigate the association between ABI, DM status, and severity of obstructive sleep apnea in people of Hispanic/Latino descent who are diverse in culture, environmental exposures, nativity, socioeconomic status, and disease burden. METHODS: A cross sectional analysis from a multi-center epidemiologic study, Hispanic Community Health Study/Study of Latinos, was utilized and included 3779 participants (mean age 55.32 ± 7.67, females 57.9%). The sample was divided into 4 groups based on the American Diabetes Association diagnostic guidelines (no DM or DM), and the ABI status (normal and abnormal). Multiple linear regression analysis was used to determine the association of the four groups and other independent variables with severity of sleep apnea measured by apnea-hypopnea index. Kruskal-Wallis H test was used for comparisons between groups for the apnea-hypopnea index. The significant level was set at 0.01. RESULTS: There were significant differences between groups in the mean of apnea-hypopnea index (P < 0.001; no DM + normal ABI = 5.42 ± 9.66, no DM + abnormal ABI = 7.11 ± 11.63, DM + normal ABI = 10.99 ± 15.16, DM + abnormal ABI = 12.81 ± 17.80). Linear regression showed that DM and abnormal ABI were significantly associated with severe sleep apnea (ß = 3.25, P = 0.001) after controlling for age, sex, BMI, income, education, alcohol use, cigarette use, hypertension or related medication, stroke and statin use. CONCLUSION: These findings suggest that people with DM and abnormal ABI were more likely to have high apnea-hypopnea index compared to the other groups. We observed gradual increasing in the severity of sleep apnea from low abnormality groups to high abnormality groups for Hispanic/Latino. Further work should elucidate the association of DM, abnormal ABI and sleep apnea with longer term outcomes, and replicate this work in different populations.