Effects of remotely-delivered cognitive behavioral therapy for insomnia in type 2 diabetes: a randomized controlled trial

Abstract

Purpose: To evaluate the effects of remotely delivered cognitive behavioral therapy for insomnia (CBTI) on subjective sleep quality, glycemic control, and objective sleep parameters in individuals with type 2 diabetes (T2D) and insomnia. Methods: Forty adults with non-insulin-treated T2D and insomnia were randomized to CBTI (n = 20) or health education (HE, n = 20), delivered weekly via one-hour online sessions for eight weeks. The primary outcome was self-reported sleep quality (Pittsburgh Sleep Quality Index, PSQI). Secondary outcomes included actigraphy-based sleep measures, glycemic control (A1C, fasting glucose), insomnia symptoms, anxiety, depression, and quality of Life. Data were collected at baseline, week 8, and week 16. Mixed-effects linear regression was used to assess between-group differences. Results: At week 8, no significant difference in PSQI was observed between groups, but the CBTI group showed improved actigraphy-based sleep regularity (variation of sleep duration), mean difference − 21.84 min (95% CI -41.64, -2.05; P = 0.031). At week 16, CBTI led to a greater reduction in anxiety symptoms (P = 0.039). There were no differences in other outcomes. In per-protocol analysis (CBTI: n = 15; HE: n = 10), CBTI resulted in improved subjective sleep quality (P = 0.042), sleep regularity (P = 0.018) and fasting glucose at week 8 (mean difference − 34.27 mg/dL; 95% CI -55.16, -13.37; P = 0.001). Satisfaction was high in both groups. Conclusion: CBTI improved sleep regularity and anxiety in T2D patients with insomnia. Adherence to CBTI also led to fasting glucose reductions, supporting its role in glycemic management. Sleep-focused interventions like CBTI should be integrated into care for T2D with insomnia to optimize sleep and metabolic outcomes.