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Discussion
To our knowledge, this is the first study to examine within-person and between-person associations between daily sleep quality and diabetes outcomes and possible mediating variables among adults with TD. In the context of a daily diary study, we found better daily sleep quality was linked to better self-care behaviors, and fewer self-regulation failures was one mechanism that explained this relation. We also found evidence that better sleep quality was linked to lower BG levels by enabling persons with TD to experience fewer self-regulation failures and engage in more self-care behaviors on a daily basis. These effects were found within subjects, meaning that we were able to explain why sleep quality on a given day was linked to better BG levels on that day within persons.
Many of the previous studies on the effect of sleep quality on diabetes outcomes have been conducted in individuals with type 2 diabetes. Among individuals with type 2 diabetes, the number of sleep awakenings using objective measures of sleep (Actigraph-wGT3X) predicts self-care along with diabetes distress, fatigue and daytime sleepiness [
35
]. Similar to our findings, Chasens et al. [
36
] found that impaired sleep quality was associated with decreased self-management behaviors and negative emotional symptoms. Poor sleep quality may lead to late-night eating habits and encourage the use of caffeine, a chemical known to increase blood glucose
254 ann. behav. med. (2020) 54:249–257

levels and duration of elevated blood glucose levels in adults with type 1 and type 2 diabetes [
37
]. A meta- analysis of individuals with type 2 diabetes also identified a relation between poor sleep quality and higher
HbA1C [
14
]. Our findings suggest that the type 2 diabetes literature related to sleep quality, self-care, and glucose levels applies to T1D.
A significant contribution of the present study was to explore potential mediators of the link between poor sleep quality and blood glucose levels. The results are consistent with the interpretation that daily poor sleep quality impairs self-regulation so that failures impede self-care behaviors and lead to higher blood glucose values. The self-regulation failures measured in the present study represent a range of failures in planning, initiation of behavior, memory, and control over emotions with regard to BG checking [
8
]. Such failures are key in understanding the dynamics of abroad range of aspects of an individual’s ability to regulate the self in relation to diabetes overtime (Turner SL, unpublished data. The results are consistent with other research suggesting that greater sleep is associated with increases in a number of facets of self-regulation, including self-monitoring as well as goal setting, which would benefit self-care behaviors The mediating roles of self-regulation failures and self-care behaviors on the relation between daily sleep quality and BG levels were only found at the within- person level, as opposed to the between-person level. The analyses performed in the present study, controlling for both between- and within-person level measures of each construct, suggest that it is daily fluctuations in these variables from one’s own average rather than between-person effects that are important for understanding these processes. The ICCs for both sleep and
BG mean revealed that the majority of the variance

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