To explore the impact of combined trajectories of sleep duration and sleep quality on diabetes risk among middle-aged and older adults, providing evidence for precision prevention and control of diabetes.

Data of the China Health and Retirement Longitudinal Survey from 2011 to 2015 were analyzed to identify the combined trajectories of sleep duration and sleep quality, employing group-based multi-trajectory modeling (GBMTM). The prevalence of diabetes among middle-aged and older adults was tracked using data from 2015 to 2020. The effect of different combined trajectories of sleep duration and sleep quality on diabetes risk was examined using Cox proportional hazards regression models. Meanwhile, subgroup analyses were conducted.

A total of 8 735 middle-aged and older adults were included. Four combined trajectories of sleep duration and sleep quality were identified: increasing sleep duration-limited improvement in sleep quality trajectory (n=1 200, 13.74%, trajectory group 1), stable short sleep duration-stable poor sleep quality trajectory (n=828, 9.48%, trajectory group 2), stable normal sleep duration-stable good sleep quality trajectory (n=5 505, 63.02%, trajectory group 3), and decreasing sleep duration-deteriorating sleep quality trajectory (n=1 202, 13.76%, trajectory group 4). Cox proportional hazards regression modeling showed that, compared with the trajectory group 3, trajectory group 1 (HR=1.29, 95% CI: 1.03-1.63), trajectory group 2 (HR=1.54, 95% CI: 1.19-1.98), trajectory group 4 (HR=1.42, 95% CI: 1.14-1.78) had a higher risk of diabetes. In the subgroup analyses, there was an interaction between sleep duration and sleep quality trajectories and gender (P=0.047).

Among middle-aged and older adults, individuals in trajectory group 1, trajectory group 2, and trajectory group 4 had an increased risk of diabetes.