Not getting enough sleep is a common affliction in the modern age. If you don’t always get as many hours of shut-eye as you’d like, perhaps you were concerned by news of a recent study that found people who sleep less than six hours a night are at higher risk of type 2 diabetes.

So what can we make of these findings? It turns out the relationship between sleep and diabetes is complex.

The study

Researchers analysed data from the UK Biobank, a large biomedical database which serves as a global resource for health and medical research. They looked at information from 247,867 adults, following their health outcomes for more than a decade.

The researchers wanted to understand the associations between sleep duration and type 2 diabetes, and whether a healthy diet reduced the effects of short sleep on diabetes risk.

As part of their involvement in the UK Biobank, participants had been asked roughly how much sleep they get in 24 hours. Seven to eight hours was the average and considered normal sleep. Short sleep duration was broken up into three categories: mild (six hours), moderate (five hours) and extreme (three to four hours). The researchers analysed sleep data alongside information about people’s diets.

Some 3.2% of participants were diagnosed with type 2 diabetes during the follow-up period. Although healthy eating habits were associated with a lower overall risk of diabetes, when people ate healthily but slept less than six hours a day, their risk of type 2 diabetes increased compared to people in the normal sleep category.

The researchers found sleep duration of five hours was linked with a 16% higher risk of developing type 2 diabetes, while the risk for people who slept three to four hours was 41% higher, compared to people who slept seven to eight hours.

One limitation is the study defined a healthy diet based on the number of servings of fruit, vegetables, red meat and fish a person consumed over a day or a week. In doing so, it didn’t consider how dietary patterns such as time-restricted eating or the Mediterranean diet may modify the risk of diabetes among those who slept less.

Also, information on participants’ sleep quantity and diet was only captured at recruitment and may have changed over the course of the study. The authors acknowledge these limitations.

Why might short sleep increase diabetes risk?

In people with type 2 diabetes, the body becomes resistant to the effects of a hormone called insulin, and slowly loses the capacity to produce enough of it in the pancreas. Insulin is important because it regulates glucose (sugar) in our blood that comes from the food we eat by helping move it to cells throughout the body.

We don’t know the precise reasons why people who sleep less may be at higher risk of type 2 diabetes. But previous research has shown sleep-deprived people often have increased inflammatory markers and free fatty acids in their blood, which impair insulin sensitivity, leading to insulin resistance. This means the body struggles to use insulin properly to regulate blood glucose levels, and therefore increases the risk of type 2 diabetes.

Further, people who don’t sleep enough, as well as people who sleep in irregular patterns (such as shift workers), experience disruptions to their body’s natural rhythm, known as the circadian rhythm.

This can interfere with the release of hormones like cortisol, glucagon and growth hormones. These hormones are released through the day to meet the body’s changing energy needs, and normally keep blood glucose levels nicely balanced. If they’re compromised, this may reduce the body’s ability to handle glucose as the day progresses.

These factors, and others, may contribute to the increased risk of type 2 diabetes seen among people sleeping less than six hours.

While this study primarily focused on people who sleep eight hours or less, it’s possible longer sleepers may also face an increased risk of type 2 diabetes.

Research has previously shown a U-shaped correlation between sleep duration and type 2 diabetes risk. A review of multiple studies found getting between seven to eight hours of sleep daily was associated with the lowest risk. When people got less than seven hours sleep, or more than eight hours, the risk began to increase.

The reason sleeping longer is associated with increased risk of type 2 diabetes may be linked to weight gain, which is also correlated with longer sleep. Likewise, people who don’t sleep enough are more likely to be overweight or obese.

Good sleep, healthy diet

Getting enough sleep is an important part of a healthy lifestyle and may reduce the risk of type 2 diabetes.

Based on this study and other evidence, it seems that when it comes to diabetes risk, seven to eight hours of sleep may be the sweet spot. However, other factors could influence the relationship between sleep duration and diabetes risk, such as individual differences in sleep quality and lifestyle.

While this study’s findings question whether a healthy diet can mitigate the effects of a lack of sleep on diabetes risk, a wide range of evidence points to the benefits of healthy eating for overall health.

The authors of the study acknowledge it’s not always possible to get enough sleep, and suggest doing high-intensity interval exercise during the day may offset some of the potential effects of short sleep on diabetes risk.

In fact, exercise at any intensity can improve blood glucose levels.

Giuliana Murfet, Casual Academic, Faculty of Health, University of Technology Sydney and ShanShan Lin, Senior Lecturer, School of Public Health, University of Technology Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Globally, the rates of common sexually transmissible infections (STIs) are increasing among people aged over 50. In some cases, rates are rising faster than among younger people.

Recent data from the United States Centers for Disease Control and Prevention shows that, among people aged 55 and older, rates of gonorrhoea and chlamydia, two of the most common STIs, more than doubled between 2012 and 2022.

Australian STI surveillance data has reflected similar trends. Between 2013 and 2022, there was a steady increase in diagnoses of chlamydia, gonorrhoea and syphilis among people aged 40 and older. For example, there were 5,883 notifications of chlamydia in Australians 40 plus in 2013, compared with 10,263 in 2022.

A 2020 study of Australian women also showed that, between 2000 and 2018, there was a sharper increase in STI diagnoses among women aged 55–74 than among younger women.

While the overall rate of common STIs is highest among young adults, the significant increase in STI diagnoses among midlife and older adults suggests we need to pay more attention to sexual health across the life course.

Why are STI rates rising among older adults?

STI rates are increasing globally for all age groups, and an increase among midlife and older people is in line with this trend.

However, increases of STIs among older people are likely due to a combination of changing sex and relationship practices and hidden sexual health needs among this group.

The “boomer” generation came of age in the 60s and 70s. They are the generation of free love and their attitude to sex, even as they age, is quite different to that of generations before them.

Given the median age of divorce in Australia is now over 43, and the internet has ushered in new opportunities for post-separation dating, it’s not surprising that midlife and older adults are exploring new sexual practices or finding multiple sexual partners.

It’s also possible midlife and older people have not had exposure to sexual health education in school or do not relate to current safe sex messages, which tend to be directed toward young people. Condoms may therefore seem unnecessary for people who aren’t trying to avoid pregnancy. Older people may also lack confidence negotiating safe sex or accessing STI screening.

Hidden sexual health needs

In contemporary life, the sex lives of older adults are largely invisible. Ageing and older bodies are often associated with loss of power and desirability, reflected in the stereotype of older people as asexual and in derogatory jokes about older people having sex.

With some exceptions, we see few positive representations of older sexual bodies in film or television.

Older people’s sexuality is also largely invisible in public policy. In a review of Australian policy relating to sexual and reproductive health, researchers found midlife and older adults were rarely mentioned.

Sexual health policy generally targets groups with the highest STI rates, which excludes most older people. As midlife and older adults are beyond childbearing years, they also do not feature in reproductive health policy. This means there is a general absence of any policy related to sex or sexual health among midlife or older adults.

Added to this, sexual health policy tends to be focused on risk rather than sexual wellbeing. Sexual wellbeing, including freedom and capacity to pursue pleasurable sexual experiences, is strongly associated with overall health and quality of life for adults of all ages. Including sexual wellbeing as a policy priority would enable a focus on safe and respectful sex and relationships across the adult life course.

Without this priority, we have limited knowledge about what supports sexual wellbeing as people age and limited funding for initiatives to engage with midlife or older adults on these issues.

How can we support sexual health and wellbeing for older adults?

Most STIs are easily treatable. Serious complications can occur, however, when STIs are undiagnosed and untreated over a long period. Untreated STIs can also be passed on to others.

Late diagnosis is not uncommon as some STIs can have no symptoms and many people don’t routinely screen for STIs. Older, heterosexual adults are, in general, less likely than other groups to seek regular STI screening.

For midlife or older adults, STIs may also be diagnosed late because some doctors do not initiate testing due to concerns they will cause offence or because they assume STI risk among older people is negligible.

Many doctors are reluctant to discuss sexual health with their older patients unless the patient explicitly raises the topic. However, older people can be embarrassed or feel awkward raising matters of sex.

Resources for health-care providers and patients to facilitate conversations about sexual health and STI screening with older patients would be a good first step.

To address rising rates of STIs among midlife and older adults, we also need to ensure sexual health promotion is targeted toward these age groups and improve accessibility of clinical services.

More broadly, it’s important to consider ways to ensure sexual wellbeing is prioritised in policy and practice related to midlife and older adulthood.

A comprehensive approach to older people’s sexual health, that explicitly places value on the significance of sex and intimacy in people’s lives, will enhance our ability to more effectively respond to sexual health and STI prevention across the life course.

Jennifer Power, Associate Professor and Principal Research Fellow, Australian Research Centre in Sex, Health and Society, La Trobe University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Ozempic and Wegovy are increasingly available in Australia and worldwide to treat type 2 diabetes and obesity.

The dramatic effects of these drugs, known as GLP-1s, on weight loss have sparked huge public interest in this new treatment option.

However, the risks and benefits are still being actively studied.

In a new study in Nature Medicine, researchers from the United States reviewed health data from about 2.4 million people who have type 2 diabetes, including around 216,000 people who used a GLP-1 drug, between 2017 and 2023.

The researchers compared a range of health outcomes when GLP-1s were added to a person’s treatment plan, versus managing their diabetes in other ways, often using glucose-lowering medications.

Overall, they found people who used GLP-1s were less likely to experience 42 health conditions or adverse health events – but more likely to face 19 others.

What conditions were less common?

Cardiometabolic conditions

GLP-1 use was associated with fewer serious cardiovascular and coagulation disorders. This includes deep vein thrombosis, pulmonary embolism, stroke, cardiac arrest, heart failure and myocardial infarction.

Neurological and psychiatric conditions

GLP-1 use was associated with fewer reported substance use disorders or addictions, psychotic disorders and seizures.

Infectious conditions

GLP-1 use was associated with fewer bacterial infections and pneumonia.

What conditions were more common?

Gastrointestinal conditions

Consistent with prior studies, GLP-1 use was associated with gastrointestinal conditions such as nausea, vomiting, gastritis, diverticulitis and abdominal pain.

Other adverse effects

Increased risks were seen for conditions such as low blood pressure, syncope (fainting) and arthritis.

How robust is this study?

The study used a large and reputable dataset from the US Department of Veterans Affairs. It’s an observational study, meaning the researchers tracked health outcomes over time without changing anyone’s treatment plan.

A strength of the study is it captures data from more than 2.4 million people across more than six years. This is much longer than what is typically feasible in an intervention study.

Observational studies like this are also thought to be more reflective of the “real world”, because participants aren’t asked to follow instructions to change their behaviour in unnatural or forced ways, as they are in intervention studies.

However, this study cannot say for sure that GLP-1 use was the cause of the change in risk of different health outcomes. Such conclusions can only be confidently made from tightly controlled intervention studies, where researchers actively change or control the treatment or behaviour.

The authors note the data used in this study comes from predominantly older, white men so the findings may not apply to other groups.

Also, the large number of participants means that even very small effects can be detected, but they might not actually make a real difference in overall population health.

Other possible reasons for these links

Beyond the effect of GLP-1 in the body, other factors may explain some of the findings in this study. For example, it’s possible that:

• people who used GLP-1 could be more informed about treatment options and more motivated to manage their own health
• people who used GLP-1 may have received it because their health-care team were motivated to offer the latest treatment options, which could lead to better care in other areas that impact the risk of various health outcomes
• people who used GLP-1 may have been able to do so because they lived in metropolitan centres and could afford the medication, as well as other health-promoting services and products, such as gyms, mental health care, or healthy food delivery services.

Did the authors have any conflicts of interest?

Two of the study’s authors declared they were “uncompensated consultants” for Pfizer, a global pharmaceutical company known for developing a wide range of medicines and vaccines. While Pfizer does not currently make readily available GLP-1s such as Ozempic or Wegovy, they are attempting to develop their own GLP-1s, so may benefit from greater demand for these drugs.

This research was funded by the US Department of Veterans Affairs, a government agency that provides a wide range of services to military veterans.

No other competing interests were reported.

Diabetes vs weight-loss treatments

Overall, this study shows people with type 2 diabetes using GLP-1 medication generally have more positive health outcomes than negative health outcomes.

However, the study didn’t include people without type 2 diabetes. More research is needed to understand the effects of these medications in people without diabetes who are using them for other reasons, including weight loss.

While the findings highlight the therapeutic benefits of GLP-1 medications, they also raise important questions about how to manage the potential risks for those who choose to use this medication.

The findings of this study can help many people, including:

• policymakers looking at ways to make GLP-1 medications more widely available for people with various health conditions
• health professionals who have regular discussions with patients considering GLP-1 use
• individuals considering whether a GLP-1 medication is right for them.

Lauren Ball, Professor of Community Health and Wellbeing, The University of Queensland and Emily Burch, Accredited Practising Dietitian and Lecturer, Southern Cross University

This article is republished from The Conversation under a Creative Commons license. Read the original article.