Objective  To analyze the association between exercise level, sleep quality, and blood glucose in patients with type 2 diabetes mellitus (T2DM), and to explore the mediating role of sleep quality between exercise level and blood glucose.

Methods  Using convenience sampling, T2DM patients from the Department of Endocrinology at Shandong Provincial Hospital from August 2022 to March 2023 were selected as research subjects. Daily exercise levels and sleep quality scores were collected via a 5-day consecutive diary, and daily average blood glucose (MG) was measured using a continuous glucose monitoring system. A multilevel structural equation modeling (MSEM) was used to analyze the association between daily exercise level, sleep quality scores, and MG at both the individual and within-individual levels, as well as the mediating effect.

Results A total of 80 T2DM patients were enrolled, with 400 valid data points collected. Correlation analysis showed that daily exercise level, daily sleep quality, and MG were significantly correlated at both the individual and within-individual levels. Multilevel mediation effect analysis showed that at the individual level, daily exercise levels affect MG through daily sleep quality; while within individuals, daily exercise level had both a direct association with MG and an indirect association through daily sleep quality.

Conclusion The roles of exercise and sleep should be emphasized in blood glucose control for T2DM patients. In clinical practice, personalized intervention measures can be developed for exercise and sleep to strengthen personalized management of  diabetes.

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