The effect of cognitive behavioral therapy for sleep and glycemic outcomes in people with diabetes: A systematic review and meta-analysis.
Yuxiao Jiao, Xiaofei He, Lulu Ma et al.
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In 30 seconds
This systematic review and meta-analysis pooled 10 randomised controlled trials involving 2,827 people with diabetes from four countries to assess cognitive behavioral therapy (CBT) for sleep and glycemic outcomes. Compared with usual care or health education, CBT improved sleep quality and reduced HbA1c; the pooled HbA1c mean difference was -0.35% (95% CI = -0.44 to -0.25; P < .00001). Insomnia severity also improved, while BMI did not. The authors noted substantial heterogeneity across several outcomes and called for higher-quality research to refine intervention protocols and identify suitable populations.
Key findings
- CBT improved sleep quality versus usual care or health education (MD = -1.47; 95% CI = -1.98 to -0.96; P < .00001; I2 = 89%).
- HbA1c was lower with CBT (MD = -0.35%; 95% CI = -0.44 to -0.25; P < .00001; I2 = 94%).
- Insomnia severity improved (MD = -2.06; 95% CI = -4.24 to 0.12; P = .004; I2 = 88%).
- BMI did not improve significantly (MD = -0.12; 95% CI = -0.72 to 0.48; P = .69; I2 = 0%).
Why it matters
Sleep problems are common in people with diabetes, and this synthesis suggests CBT may benefit both sleep quality and glycemic control. The findings connect a sleep-focused intervention with an important diabetes outcome, while the high heterogeneity for several measures cautions against assuming consistent effects across settings or protocols.
What to keep in mind
The pooled estimates showed substantial heterogeneity for sleep quality, HbA1c, and insomnia severity. The authors also identify a need for higher-quality research to optimise protocols and define target populations.