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Link Between Daily Sleep and BG Levels Mediated



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Link Between Daily Sleep and BG Levels Mediated
through Self-regulation Failures and Self-care Behaviors
Sequentially
We examined the relation between daily sleep quality and daily BG mean and the sequential mediating roles of daily self-regulation failures and self-care behaviors for within-person and between-person effects simultaneously (see Fig. 2
for full model results. Analyses revealed a within-person effect of persons with T1D’s daily sleep quality on their daily BG mean, indicating that on days when persons with TD reported having better daily sleep quality the prior evening than their average, they had lower daily BG mean that day (B = −4.04,
SE = 1.35, p = .003, CI [−6.68; −1.40]). Furthermore, a significant within-person effect of persons with T1D’s daily sleep quality on daily self-regulation failures was found such that on days when persons with TD reported having better daily sleep quality the prior evening than their average, they reported lower daily self-regulation failures (B = −.03, SE = .01, p = .008, CI [−.06; −.01]). Also, analyses revealed a significant within-person effect of persons with T1D’s daily self-regulation failures on daily self-care behaviors, such that on days when persons with TD reported higher daily self-regulation failures than their average, they reported lower self-care behaviors (B = −.29, SE = .04, p = < .001, CI [−.38; −.20]).
Furthermore, analyses revealed a significant within- person effects of persons with T1D’s daily self-care behaviors on daily BG levels, such that on days when persons with T1D reported higher daily self-care be- haviors than their average, they had healthier BG levels
(B = −20.01, SE = 3.89, p < .001, CI [−27.63; −12.40]).
We examined the sequential multiple mediating roles of self-regulation failures and self-care behaviors between sleep quality and BG mean for within-person effect.
Analyses revealed significant indirect within-person ef- fects. A chain of daily self-regulation failures and daily self-care behaviors partially mediated the association between daily sleep quality and daily BG mean. In other words, on days persons with T1D reported better sleep quality than their average, they reported lower self-regulation failures and then higher daily self-care behaviors leading to a decrease in BG mean (B = −.18,
SE = .08, p = .02, CI [−.34; −.03]; see Fig. 2
for within- person effect results).
Analyses revealed that there was no between-person effect of persons with T1D’s sleep quality on their
BG mean (B = −4.64, SE = 4.83, p = .19, CI [−14.10;
4.82]) and no significant between-person indirect effect
(B = −1.28, SE = .86, p = .14, CI [−2.97; .41]; see Fig. for between-person effect results).
Additional analyses were conducted to understand how sleep quality was associated with another metric of BG levels (i.e., ADRR) and underlying mechanisms of this association. We found similar findings to those examined between sleep quality and BG mean. We addressed whether models were consistent across treatment regimen (CGM or daily injections) as the regulatory demands experienced by those on CGM could be lessened. Further as length of diagnosis frequently affects blood glucose, we controlled for this variable assessed via persons with T1D’s report. With these covariates included, we replicated the results.

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