Type 2 diabetes and insomnia: Impact on metabolic control

Diabetes is one of the most serious health challenges in the United States, affecting nearly 21 million Americans. The goal of diabetes management is to maintain the blood glucose close to normal to prevent diabetic complications and therefore extending life expectancy and improving quality of life. Research now indicates a relationship of the quantity and quality of sleep to glycemic control in type 2 diabetics. No research on the impact of insomnia on diabetes prevention and/or management was found in the literature. The purpose of this 11 week intervention study was to examine the effects of participation in Cognitive Behavioral Therapy for Insomnia (CBTI) on the sleep quality, quantity and insomnia severity of aging women (50-74 years) with type 2 diabetes for at least one year and insomnia for a minimum of six months. The secondary purpose was to determine the relationship among changes in sleep quality and quantity, metabolic control and diabetes self-management behaviors. Nine participants aged 56 to 69 completed the orientation, seven week intervention and 3-week follow-up. The global sleep quality scores, measured by the Pittsburgh Sleep Quality Index, demonstrated an improvement in sleep quality. Insomnia severity, as measured by the Insomnia Severity Index, was found to decrease insomnia severity from the moderate level insomnia group to the sub threshold insomnia group. Although sleep quantity, as measured by the Actiwatch 2, decreased during the intervention as a result of sleep restriction the amount of sleep had begun to increase at posttest. Using the Physical Activity Scale, the mean number of minutes in seven of the eight measures increased from pretest to 3-week follow-up. Using the Analog Scale for Appetite, appetite for sweets was found to significantly decrease as the sleep quality improved. Eight of the nine participants were found to have lower A1C levels at the 3-week follow-up. In summary, CBTI was found to improve self-reported sleep quality. As a result, physical activity increased and appetite decreased, especially for sweet foods. Hemoglobin A1C levels decreased in eight of the nine participants. Improved insomnia may improve metabolic control and improve diabetes self-management behaviors. Additional research is needed.