Role of Sleep Disturbances and Diabetes-Related Distress on Glycemic Control: A Path Analysis

Despite advancements in diabetes management technology, many patients with type 2 diabetes (T2D) struggle to achieve optimal glycemic control. Sleep disorders such as obstructive sleep apnea (OSA) and insomnia are common in T2D and linked to poor glycemic control. Insomnia, particularly with short sleep duration, may worsen glycemic control by increasing diabetes-related distress. To improve glucose management, the association among sleep duration, insomnia severity, diabetes-related distress, and glycemic control needs to be further evaluated. A path analysis was conducted using data from 237 adults with T2D and OSA from the total of 406 participants who completed the baseline assessment in the Diabetes Sleep Treatment Trial (DSTT; N = 351) and the Diabetes Sleep Treatment Trial for Insomnia (DSTT-I; N = 55). Parent studies were conducted from July 2013 to June 2018 (DSTT) and from April 2017 to March 2020 (DSTT-I). Sleep duration was assessed using the Pittsburgh Sleep Quality Index, insomnia severity using the Insomnia Severity Index, and diabetes-related distress using the Problem Areas in Diabetes. Glycemic control was measured by hemoglobin A1c. The results showed that shorter sleep duration indirectly worsened glycemic control by increasing insomnia severity, which, in turn, elevated diabetes-related distress after controlling for obstructive sleep apnea severity, age, sex, marital status, race, education level, and financial difficulty. These findings suggest that sleep duration may be a modifiable factor for improving insomnia severity, reducing diabetes-related distress, and enhancing glycemic control in T2D. Optimizing sleep duration as part of clinical diabetes management may help improve glucose regulation.