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Insomnia symptoms as a cause of type 2 diabetes Incidence: a 20 year cohort study

Green, Michael J and Espie, Colin A and Popham, Frank and Robertson, Tony and Benzeval, Michaela (2017) 'Insomnia symptoms as a cause of type 2 diabetes Incidence: a 20 year cohort study.' BMC Psychiatry, 17. ISSN 1471-244X

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Abstract

Background Insomnia symptoms are associated with type 2 diabetes incidence but are also associated with a range of potential time-varying covariates which may confound and/or mediate associations. We aimed to assess whether cumulative exposure to insomnia symptoms has a causal effect on type 2 diabetes incidence. Methods A prospective cohort study in the West of Scotland, following respondents for 20 years from age 36. 996 respondents were free of diabetes at baseline and had valid data from up to four follow-up visits. Type 2 diabetes was assessed at the final visit by self-report, taking diabetic medication, or blood-test (HbA1c ≥ 6.5% or 48 mmol/mol). Effects of cumulative insomnia exposure on type 2 diabetes incidence were estimated with traditional regression and marginal structural models, adjusting for time-dependent confounding (smoking, diet, physical inactivity, obesity, heavy drinking, psychiatric distress) as well as for gender and baseline occupational class. Results Traditional regression yielded an odds ratio (OR) of 1.34 (95% CI: 1.06-1.70) for type 2 diabetes incidence for each additional survey wave in which insomnia was reported. Marginal structural models adjusted for prior covariates (assuming concurrently measured covariates were potential mediators), reduced this OR to 1.20 (95% CI: 0.98-1.46), and when concurrent covariates were also included (viewing them as potential confounders) this dropped further to 1.08 (95% CI: 0.85-1.37). Conclusions The association between cumulative experience of insomnia and type 2 diabetes incidence appeared confounded. Evidence for a residual causal effect depended on assumptions as to whether concurrently measured covariates were confounders or mediators

Item Type: Article
Uncontrolled Keywords: Insomnia; Sleep; Type 2 Diabetes; Longitudinal; Confounding; Causal Effects; Marginal Structural Models
Subjects: H Social Sciences > H Social Sciences (General)
R Medicine > R Medicine (General)
Divisions: Faculty of Social Sciences > Institute for Social and Economic Research
Depositing User: Elements
Date Deposited: 11 Jul 2018 15:44
Last Modified: 11 Jul 2018 15:44
URI: http://repository.essex.ac.uk/id/eprint/22649

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