Photo Credit: Yutthana Gaetgeaw

CBT-I shows promise as a non-pharmacological intervention to improve sleep and mood in T2D, potentially benefiting glycemic control and metabolic health.

Researchers aimed to determine if online cognitive behavioral therapy for insomnia (CBT-I) could enhance glycemic and metabolic control, mood, QOL, and insomnia symptoms in adults with type 2 diabetes (T2D) and to explore the mediating role of lifestyle factors. Participants with T2D and insomnia were randomized to either CBT-I or usual care. Primary outcomes included HbA1c levels, while secondary outcomes comprised glycemic and metabolic parameters, sleep, mood, and QOL. Assessments were conducted at baseline, three months, and six months.

In total, 57 participants were randomized—29 to CBT-I and 28 to usual care. Intention-to-treat analysis showed no significant differences in primary and most secondary outcomes between the groups, according to findings published in Sleep Medicine. However, the intervention group exhibited a notable decrease in insomnia and depressive symptoms and an increase in BMI. Notably, only half of the participants in the intervention group completed the CBT-I.

The protocol analysis focused on those who adhered to the CBT-I, indicating a non-significant trend towards improved HbA1c and glucose levels, enhanced metabolic outcomes, and better QOL. Significant reductions in insomnia and depressive symptoms were observed compared to the control group. Lifestyle factors were found to partially mediate the intervention’s effects.

The study concluded that while CBT-I might not significantly improve glycemic control or metabolic outcomes, it can effectively reduce insomnia and depressive symptoms in people with T2D. The limited adherence to the intervention and the small sample size were highlighted as potential factors affecting the significance of the results. Additionally, the study noted that future research with larger sample sizes and longer follow-up periods is necessary to confirm the observed trends and improve generalizability.

Overall, CBT-I shows promise as a non-pharmacological intervention to improve sleep and mood in patients with T2D, potentially benefiting their glycemic control and metabolic health. However, strategies to enhance adherence and further investigate the mediating role of lifestyle factors are crucial for optimizing its clinical utility.

“[F]or the sleep parameters, we observed positive effects for the intervention, which is consistent with the studies included in the meta-analyses on CBT in the general population as well as to the two trials in people with T2D,” the authors concluded. “Likewise, the effects on mood were consistent with earlier RCTs in the general care population, showing a decrease in depressive symptoms.”