Araştırma Makalesi
BibTex RIS Kaynak Göster

Diabetes mellitusta uyku ile metabolik faktörler arasındaki ilişki

Yıl 2020, Cilt: 5 Sayı: 3, 62 - 68, 18.11.2020

Zeynep Altın Burcu Bayrak

https://doi.org/10.22391/fppc.747615

Öz

Giriş: Bu çalışmada, Diabetes Mellitus tanısı ile takip edilen hastalarda, sosyodemografik özellikler, kan basıncı, beden kitle indeksi, ek hastalıklar, diyabet süresi, medikal tedavi ve biyokimyasal parametreler ile uyku durumu arasındaki ilişkinin araştırılması amaçlanmıştır.

Yöntem: Bu prospektif ve kesitsel çalışma 1 Haziran- 31 Ağustos 2019 tarihleri arasında İç hastalıkları polikliniğine başvuran 200 Diabetes Mellitus tanılı hasta ile yürütülmüştür. Katılımcıların uyku durumu, Pittsburgh Uyku Kalitesi İndeksi (PUKİ) ile değerlendirilmiştir. PUKİ toplam puanı 5 ve üzeri uyku kalitesi kötü, toplam puan 5’in altı ise iyi uyku kalitesi olarak sınıflandırılmıştır.

Bulgular: Çalışmaya dahil edilen 200 katılımcının yaş ortalaması 57,40±12,86 idi. Katılımcıların %64’ü (n=128) kadın, %36’sı (n=72) erkekti. Hastaların PUKİ toplam puan ortalaması 10,44 idi. Katılımcıların %7,5’inde uyku kalitesi iyi, %92,5’inde ise kötü saptandı. Erkeklerde (p=0,010), eğitim düzeyi yüksek olanlarda (p=0,012) uyku kalitesi daha yüksek saptandı. Diabetes Mellitusa, hipertansiyon, hiperlipidemi veya koroner arter hastalığının eşlik ettiği durumlarda da (p=0,028) uyku kalitesi daha düşük saptandı. Diabetes Mellitus tipi, vücut kitle indeksi (VKİ), kan basıncı, lipit değerleri, açlık ve tokluk kan şekeri, kreatinin ve ALT değerleri ile PUKİ toplam puan ortalamaları arasında istatistiksel olarak anlamlı fark bir bulunmadı (p>0,05).

Sonuç: Diabetes Mellitus tanısı ile takip edilen hastaların uyku kalitesi kötü saptanmıştır. Bozulmuş uyku kalitesi birçok hastalığın etyolojisi ve seyrinde rol alabilir. Klinisyenler, Diabetes Mellitus takibinde hastaların uyku durumları ile de ilgilenmelidir. Diabetes Mellitus nedeni ile takip edilen hastaların uyku kalitesinin artırılması için müdahalelerde bulunulması, hastaların yaşam kalitesini artırabilir.

Anahtar Kelimeler

Diabetes mellitus uyku kan şekeri koroner arter hastalığı hiperlipidemi

Kaynakça

  • 1. Altin Z: [Common chronic diseases with aging] (in Turkish) In: [Multidisciplinary approaches to aging from the healths sociology perspective] (in Turkish), Sahin SD (editor). Istanbul: Ekin publishing; 2020:139-56.
  • 2. IDF Diabetes Atlas. Available at: http://www.diabetesatlas.org (Access Date: January 18, 2019).
  • 3. Xu G, Liu B, Sun Y, Du Y, Snetselaar LG, Hu FB et al. Prevalence of diagnosed type 1 and type 2 diabetes among US adults in 2016 and 2017: population based study. BMJ 2018;362:k1497. https://doi.org/10.1136/bmj.k1497
  • 4. Centers for Disease Control and Prevention. National diabetes statistics report 2017. Available at: https://www.cdc.gov/diabetes/data/statistics/statistics-report.html (Access Date: January 18, 2019).
  • 5. Turkey diabetes program 2015-2020. Available at: https://extranet.who.int/ncdccs/Data/TUR_D1_T%C3%BCrkiye%20Diyabet%20Program%C4%B1%202015-2020.pdf (Access Date: May 31, 2020) (in Turkish)
  • 6. Dietz WH, Robinson TN. Clinical practice. Overweight children and adolescents. N Engl J Med 2005;352:2100-9. https://doi.org/10.1056/nejmcp043052
  • 7. Roglic G, Unwin N, Bennett PH, Mathers C, Tuomilehto J, Nag Setal. The burden of mortality attributable to diabetes. Realistic estimates for the year 2000. Diabetes Care 2005;28(9):2130–5. https://doi.org/10.2337/diacare.28.9.2130
  • 8. Karadag M. [Sleep disorders classification (ICSD-2)] (in Turkish). Turk Clinics Arch Lung 2007;8:88-91. Available at: http://uykubozuklugu.uludag.edu.tr/siniflama.pdf (Access Date: June 1, 2020)
  • 9. Potter PA, Perry AG. Fundamentals of nursing, 6th edition, Elsevier mosby, St.Louispp: 1198-227. Available at: https://www.elsevier.com/books/potter-and-perrys-fundamentals-of-nursing-australian-version/crisp/978-0-7295-7862-2 (Access Date: May 31, 2020)
  • 10. Spiegel K, Knutson K, Leproult R, Tasali E, Cauter VE. Sleep loss: a novel risk factor for insulin resistance and type 2 diabetes. J Appl Physiol 2005;99(5):2008-19. https://pubmed.ncbi.nlm.nih.gov/16227462
  • 11. Marathe PH, Gao HX, Kapat KL. American Diabetes Association standards of medical care in diabetes. J Diabetes 2017;9(4):320-4. https://doi.org/10.1111/1753-0407.12524
  • 12. Sharma S, Kavuru M. Sleep and metabolism: an overview. Int J Endocrinol 2010;2010:1-12. https://doi.org/10.1155/2010/270832
  • 13. Folstein MF, Folstein S, Mc Hugh PR. "Mini mental state" A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12(3):189-98. https://doi.org/10.1016/0022-3956(75)90026-6
  • 14. Molloy DW, Standish TIM. A guide to the standardized mini mental state examination. Int Psychogeriatrics 1997;9:87-94. https://doi.org/10.1017/S1041610297004754
  • 15. Gungen C, Ertan T, Eker E, Yasar R, Engin F. Reliability and validity of the standardized mini mental state examination in the diagnosis of mild dementia in Turkish population. Turk J of Psychiatry 2002;13(4):273-81. https://pubmed.ncbi.nlm.nih.gov/12794644
  • 16. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Research 1989;28:193–213. https://doi.org/10.1016/0165-1781(89)90047-4
  • 17. Agargun M, Kara H, Anlar O. [Validity and reliability of Pittsburgh sleep quality index] (in Turkish). Turk J of Psychiatry 1996;7:107-15. Available at: https://ci.nii.ac.jp/naid/20001210233 (Access Date: January 18, 2019).
  • 18. Silva M, Chaves C, Duarte J, Amaral O, Ferreira M. Sleep quality determinants among nursing students. Procedia – Soc Behav Sc 2016;217:999-1007. https://doi.org/10.1016/j.sbspro.2016.02.090
  • 19. Tsai YW, Kann NH, Tung TH, Chao YJ, Lin CJ, Chang KC, et al. Impact of subjective sleep quality on glycemic control in type 2 diabetes mellitus. Fam Pract 2012;29(1):30-5. https://doi.org/10.1093/fampra/cmr041
  • 20. Aysan E, Karakose S, Zaybak A, Ismailoglu EG. [Sleep quality in university students and affecting factors] (in Turkish). Dokuz Eylul Univ School Nurs Electron J 2014:7(3):193-8 Available at: https://dergipark.org.tr/tr/download/article-file/753356 (Access Date: June 20, 2020).
  • 21. Akova I, Kocoglu G. [Relationships between sleep time, quality, physical activity level and some anthropometric measurements in adults over 20 years of age] (in Turkish). Ahi Evran Med J 2018;2(3);67-73. Available at: https://dergipark.org.tr/tr/download/article-file/612245 (Access Date: June 20, 2020).
  • 22. Reutrakul S, Thakkinstian A, Anothaisintawee T, Chontong S, Borel AL, Perfect MM.et al. Sleep characteristics in type 1 diabetes and associations with glycemic control: systematic review and meta-analysis. Sleep Med 2016;23:26–45. https://doi.org/10.1016/j.sleep.2016.03.019
  • 23. Sakamoto R, Yamakawa T, Takahashi K, Suzuki J, Shinoda MM, Sakamaki K, et al. Association of usual sleep quality and glycemic control in type 2 diabetes in Japanese: A cross sectional study. Sleep and Food Registry in Kanagawa (SOREKA). PloS One 2018;13(1):e0191771. https://doi.org/10.1371/journal.pone.0191771
  • 24. Björkelund C, Carlson DB, Lapidus Letal. Sleep disturbances in midlife unrelated to 32 – year diabetes incidence. Diabetes Care 2005;28(11):2739-44. https://doi.org/10.2337/diacare.28.11.2739
  • 25. Hayashino Y, Yamazaki S, Nakayama T, Sokejima S, Fukuhara S. Relationship between diabetes mellitus and excessive sleepiness during driving. Exp Clin Endocrinol Diabetes 2008;116(01):1–5. https://doi.org/10.1055/s-2007-984442
  • 26. Gunes Z, Korukcu O, Ozdemir G. [Determination of sleep quality in patients with diabetes] (in Turkish). Ataturk Univ J Nurs School 2009;12(2):10-7. Available at: https://dergipark.org.tr/tr/download/article-file/29456 (Access Date: June 30, 2020).
  • 27. Einhorn D, Stewart DA, Erman M, Gordon N, Tsimikas AP, Casal E. Prevalence apne a in a population of adults with type 2 diabetes mellitus. Endocrin Pract 2007;13(4):355-62. https://doi.org/10.4158/EP.13.4.355
  • 28. Doi Y, Minowa M, Uchiyama M, Okawa M. Subjective sleep quality and sleep problems in the general Japanese adult population. Psychiatry Clin Neurosci 2001;55, 213–5. https://doi.org/10.1046/j.1440-1819.2001.00830.x
  • 29. Vgontzas AN, Zoumakis E, Bixler EO, Lin HM, Follett H, Kales A, et al. Adverse effects of modest sleep restriction on sleepiness, performance, and inflammatory cytokines. J Clin Endocrinol Metab 2004;89(5):2119-26. https://doi.org/10.1210/jc.2003-031562
  • 30. Pillar G, Schuscheim G, Weiss R, Malhotra A, McCowen KC, Shlitner A, et al. Interactions between hypoglycemia and sleep architecture in children with type 1 diabetes mellitus. J Pediatr 2003;142(2):163-8. https://doi.org/10.1067/mpd.2003.66
  • 31. Lopes LA, Lins CM, Adeodato VG, Quental DP, Bruin PFC, Montenegro RM, et al. Restless legs syndrome and quality of sleep in type 2 diabetes. Diabetes Care 2005;28(11):2633-6. https://doi.org/10.2337/diacare.28.11.2633
  • 32. Zhu B, Hershberger PE, Kapella MC, FritschiC. The relationship between sleep disturbance and glycaemic control in adults with type 2 diabetes: An integrative review. J Clin Nurs 2017;26(23-24):4053–64. https://doi.org/10.1111/jocn.13899
  • 33. Lee S, Ng KY, Chin WK. The impact of sleep amount and sleep quality on glycemic control in type 2 diabetes: A systematic review and meta-analysis. Sleep Med Rev 2017;31: 91–101. https://doi.org/10.1016/j.smrv.2016.02.001

The relationship between sleep and metabolic factors in diabetes mellitus

Yıl 2020, Cilt: 5 Sayı: 3, 62 - 68, 18.11.2020

Zeynep Altın Burcu Bayrak

https://doi.org/10.22391/fppc.747615

Öz

Introduction: This study was conducted to determine the relationship between sleep status and sociodemographic features, body mass index (BMI), blood pressure (BP), additional diseases, duration of diabetes mellitus diagnosis, received therapies, and laboratory values in patients with diabetes mellitus.

Methods: The study was carried out with 200 adult diabetic patients applying to the Internal Medicine Department of Tepecik Training and Research Hospital with normal cognitive function and without any known psychiatric disorder. The research was conducted between July 10 and August 31, 2019. Sociodemographic data of patients were recorded, and the Pittsburgh Sleep Quality Index (PSQI) was applied. Those with a total score of 5 or above were considered poor, while those less than 5 were deemed good.

Results: Of the 200 patients, 64% (n = 128) were female, and 36% (n = 72) were male. The mean total PDQI score was 10.44. Sleep quality was good in 7.5%, while poor in 92.5%. In both genders, the mean total score was greater than five. However, there was a statistically significant difference according to gender. Namely, 3.9% of women had good sleep quality, which was 13.9% among men (p=0.010). Higher educational status was related to higher sleep quality (p=0.007). Sleep quality was further impaired in patients with additional hypertension, hyperlipidemia, or coronary artery disease (p=0.010). The sleep quality of those living with their spouses was lower than that of other participants (p=0.033). There was no statistically significant difference between mean PUKI total scores and diabetes type, BMI, BP, lipid values, fasting & postprandial blood glucose, creatinine, or ALT values (p>0.05).

Conclusion: Sleep quality is poor in diabetics. Clinicians should handle patients' sleep status during diabetes mellitus follow-up. Interventions to increase sleep quality in diabetics will no doubt improve the quality of life.

Anahtar Kelimeler

Diabetes mellitus sleep blood glucose coronary artery disease hyperlipidemias

Kaynakça

  • 1. Altin Z: [Common chronic diseases with aging] (in Turkish) In: [Multidisciplinary approaches to aging from the healths sociology perspective] (in Turkish), Sahin SD (editor). Istanbul: Ekin publishing; 2020:139-56.
  • 2. IDF Diabetes Atlas. Available at: http://www.diabetesatlas.org (Access Date: January 18, 2019).
  • 3. Xu G, Liu B, Sun Y, Du Y, Snetselaar LG, Hu FB et al. Prevalence of diagnosed type 1 and type 2 diabetes among US adults in 2016 and 2017: population based study. BMJ 2018;362:k1497. https://doi.org/10.1136/bmj.k1497
  • 4. Centers for Disease Control and Prevention. National diabetes statistics report 2017. Available at: https://www.cdc.gov/diabetes/data/statistics/statistics-report.html (Access Date: January 18, 2019).
  • 5. Turkey diabetes program 2015-2020. Available at: https://extranet.who.int/ncdccs/Data/TUR_D1_T%C3%BCrkiye%20Diyabet%20Program%C4%B1%202015-2020.pdf (Access Date: May 31, 2020) (in Turkish)
  • 6. Dietz WH, Robinson TN. Clinical practice. Overweight children and adolescents. N Engl J Med 2005;352:2100-9. https://doi.org/10.1056/nejmcp043052
  • 7. Roglic G, Unwin N, Bennett PH, Mathers C, Tuomilehto J, Nag Setal. The burden of mortality attributable to diabetes. Realistic estimates for the year 2000. Diabetes Care 2005;28(9):2130–5. https://doi.org/10.2337/diacare.28.9.2130
  • 8. Karadag M. [Sleep disorders classification (ICSD-2)] (in Turkish). Turk Clinics Arch Lung 2007;8:88-91. Available at: http://uykubozuklugu.uludag.edu.tr/siniflama.pdf (Access Date: June 1, 2020)
  • 9. Potter PA, Perry AG. Fundamentals of nursing, 6th edition, Elsevier mosby, St.Louispp: 1198-227. Available at: https://www.elsevier.com/books/potter-and-perrys-fundamentals-of-nursing-australian-version/crisp/978-0-7295-7862-2 (Access Date: May 31, 2020)
  • 10. Spiegel K, Knutson K, Leproult R, Tasali E, Cauter VE. Sleep loss: a novel risk factor for insulin resistance and type 2 diabetes. J Appl Physiol 2005;99(5):2008-19. https://pubmed.ncbi.nlm.nih.gov/16227462
  • 11. Marathe PH, Gao HX, Kapat KL. American Diabetes Association standards of medical care in diabetes. J Diabetes 2017;9(4):320-4. https://doi.org/10.1111/1753-0407.12524
  • 12. Sharma S, Kavuru M. Sleep and metabolism: an overview. Int J Endocrinol 2010;2010:1-12. https://doi.org/10.1155/2010/270832
  • 13. Folstein MF, Folstein S, Mc Hugh PR. "Mini mental state" A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12(3):189-98. https://doi.org/10.1016/0022-3956(75)90026-6
  • 14. Molloy DW, Standish TIM. A guide to the standardized mini mental state examination. Int Psychogeriatrics 1997;9:87-94. https://doi.org/10.1017/S1041610297004754
  • 15. Gungen C, Ertan T, Eker E, Yasar R, Engin F. Reliability and validity of the standardized mini mental state examination in the diagnosis of mild dementia in Turkish population. Turk J of Psychiatry 2002;13(4):273-81. https://pubmed.ncbi.nlm.nih.gov/12794644
  • 16. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Research 1989;28:193–213. https://doi.org/10.1016/0165-1781(89)90047-4
  • 17. Agargun M, Kara H, Anlar O. [Validity and reliability of Pittsburgh sleep quality index] (in Turkish). Turk J of Psychiatry 1996;7:107-15. Available at: https://ci.nii.ac.jp/naid/20001210233 (Access Date: January 18, 2019).
  • 18. Silva M, Chaves C, Duarte J, Amaral O, Ferreira M. Sleep quality determinants among nursing students. Procedia – Soc Behav Sc 2016;217:999-1007. https://doi.org/10.1016/j.sbspro.2016.02.090
  • 19. Tsai YW, Kann NH, Tung TH, Chao YJ, Lin CJ, Chang KC, et al. Impact of subjective sleep quality on glycemic control in type 2 diabetes mellitus. Fam Pract 2012;29(1):30-5. https://doi.org/10.1093/fampra/cmr041
  • 20. Aysan E, Karakose S, Zaybak A, Ismailoglu EG. [Sleep quality in university students and affecting factors] (in Turkish). Dokuz Eylul Univ School Nurs Electron J 2014:7(3):193-8 Available at: https://dergipark.org.tr/tr/download/article-file/753356 (Access Date: June 20, 2020).
  • 21. Akova I, Kocoglu G. [Relationships between sleep time, quality, physical activity level and some anthropometric measurements in adults over 20 years of age] (in Turkish). Ahi Evran Med J 2018;2(3);67-73. Available at: https://dergipark.org.tr/tr/download/article-file/612245 (Access Date: June 20, 2020).
  • 22. Reutrakul S, Thakkinstian A, Anothaisintawee T, Chontong S, Borel AL, Perfect MM.et al. Sleep characteristics in type 1 diabetes and associations with glycemic control: systematic review and meta-analysis. Sleep Med 2016;23:26–45. https://doi.org/10.1016/j.sleep.2016.03.019
  • 23. Sakamoto R, Yamakawa T, Takahashi K, Suzuki J, Shinoda MM, Sakamaki K, et al. Association of usual sleep quality and glycemic control in type 2 diabetes in Japanese: A cross sectional study. Sleep and Food Registry in Kanagawa (SOREKA). PloS One 2018;13(1):e0191771. https://doi.org/10.1371/journal.pone.0191771
  • 24. Björkelund C, Carlson DB, Lapidus Letal. Sleep disturbances in midlife unrelated to 32 – year diabetes incidence. Diabetes Care 2005;28(11):2739-44. https://doi.org/10.2337/diacare.28.11.2739
  • 25. Hayashino Y, Yamazaki S, Nakayama T, Sokejima S, Fukuhara S. Relationship between diabetes mellitus and excessive sleepiness during driving. Exp Clin Endocrinol Diabetes 2008;116(01):1–5. https://doi.org/10.1055/s-2007-984442
  • 26. Gunes Z, Korukcu O, Ozdemir G. [Determination of sleep quality in patients with diabetes] (in Turkish). Ataturk Univ J Nurs School 2009;12(2):10-7. Available at: https://dergipark.org.tr/tr/download/article-file/29456 (Access Date: June 30, 2020).
  • 27. Einhorn D, Stewart DA, Erman M, Gordon N, Tsimikas AP, Casal E. Prevalence apne a in a population of adults with type 2 diabetes mellitus. Endocrin Pract 2007;13(4):355-62. https://doi.org/10.4158/EP.13.4.355
  • 28. Doi Y, Minowa M, Uchiyama M, Okawa M. Subjective sleep quality and sleep problems in the general Japanese adult population. Psychiatry Clin Neurosci 2001;55, 213–5. https://doi.org/10.1046/j.1440-1819.2001.00830.x
  • 29. Vgontzas AN, Zoumakis E, Bixler EO, Lin HM, Follett H, Kales A, et al. Adverse effects of modest sleep restriction on sleepiness, performance, and inflammatory cytokines. J Clin Endocrinol Metab 2004;89(5):2119-26. https://doi.org/10.1210/jc.2003-031562
  • 30. Pillar G, Schuscheim G, Weiss R, Malhotra A, McCowen KC, Shlitner A, et al. Interactions between hypoglycemia and sleep architecture in children with type 1 diabetes mellitus. J Pediatr 2003;142(2):163-8. https://doi.org/10.1067/mpd.2003.66
  • 31. Lopes LA, Lins CM, Adeodato VG, Quental DP, Bruin PFC, Montenegro RM, et al. Restless legs syndrome and quality of sleep in type 2 diabetes. Diabetes Care 2005;28(11):2633-6. https://doi.org/10.2337/diacare.28.11.2633
  • 32. Zhu B, Hershberger PE, Kapella MC, FritschiC. The relationship between sleep disturbance and glycaemic control in adults with type 2 diabetes: An integrative review. J Clin Nurs 2017;26(23-24):4053–64. https://doi.org/10.1111/jocn.13899
  • 33. Lee S, Ng KY, Chin WK. The impact of sleep amount and sleep quality on glycemic control in type 2 diabetes: A systematic review and meta-analysis. Sleep Med Rev 2017;31: 91–101. https://doi.org/10.1016/j.smrv.2016.02.001
Toplam 33 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular İç Hastalıkları
Bölüm Araştırma Makalesi (Original Article)
Yazarlar

Zeynep Altın 0000-0003-3682-1479

Burcu Bayrak 0000-0001-9359-5100

Yayımlanma Tarihi 18 Kasım 2020
Gönderilme Tarihi 3 Haziran 2020
Kabul Tarihi 3 Kasım 2020
Yayımlandığı Sayı Yıl 2020Cilt: 5 Sayı: 3

Kaynak Göster

APA Altın, Z., & Bayrak, B. (2020). The relationship between sleep and metabolic factors in diabetes mellitus. Family Practice and Palliative Care, 5(3), 62-68. https://doi.org/10.22391/fppc.747615
AMA Altın Z, Bayrak B. The relationship between sleep and metabolic factors in diabetes mellitus. Fam Pract Palliat Care. Aralık 2020;5(3):62-68. doi:10.22391/fppc.747615
Chicago Altın, Zeynep, ve Burcu Bayrak. “The Relationship Between Sleep and Metabolic Factors in Diabetes Mellitus”. Family Practice and Palliative Care 5, sy. 3 (Aralık 2020): 62-68. https://doi.org/10.22391/fppc.747615.
EndNote Altın Z, Bayrak B (01 Aralık 2020) The relationship between sleep and metabolic factors in diabetes mellitus. Family Practice and Palliative Care 5 3 62–68.
IEEE Z. Altın ve B. Bayrak, “The relationship between sleep and metabolic factors in diabetes mellitus”, Fam Pract Palliat Care, c. 5, sy. 3, ss. 62–68, 2020, doi: 10.22391/fppc.747615.
ISNAD Altın, Zeynep - Bayrak, Burcu. “The Relationship Between Sleep and Metabolic Factors in Diabetes Mellitus”. Family Practice and Palliative Care 5/3 (Aralık 2020), 62-68. https://doi.org/10.22391/fppc.747615.
JAMA Altın Z, Bayrak B. The relationship between sleep and metabolic factors in diabetes mellitus. Fam Pract Palliat Care. 2020;5:62–68.
MLA Altın, Zeynep ve Burcu Bayrak. “The Relationship Between Sleep and Metabolic Factors in Diabetes Mellitus”. Family Practice and Palliative Care, c. 5, sy. 3, 2020, ss. 62-68, doi:10.22391/fppc.747615.
Vancouver Altın Z, Bayrak B. The relationship between sleep and metabolic factors in diabetes mellitus. Fam Pract Palliat Care. 2020;5(3):62-8.

Family Practice and Palliative Care      ISSN 2458-8865       E-ISSN 2459-1505