TOPLINE

Compared with an attention control intervention, a remotely delivered sleep-optimization intervention reduced A1c in adults with type 1 diabetes (T1D) who had baseline A1c ≥ 7% (≥ 53 mmol/mol), with reductions of 0.32% at 12 weeks and 0.44% at 24 weeks. The intervention also eased diabetes distress and improved self-reported sleep quality at 6 weeks.

METHODOLOGY

• About 40% of adults with T1D don’t get enough sleep, and there’s increasing interest in using sleep-focused behavioral programs to boost their health.
• A total of 144 adults (mean age, 38 years; 65% women) with T1D and short sleep (< 6.5 h/night) or irregular sleep (variability of sleep duration ≥ 1 h) were randomly assigned to either the Sleep-Opt (n = 73) or an attention control (Healthy Living; n = 71) intervention in this remotely delivered clinical trial conducted in the US from January 2021 to December 2024; actigraphy was used to confirm short or irregular sleep.
• Participants in the Sleep-Opt group received a Fitbit sleep tracker, a smartphone application with interactive feedback, didactic content, and telephone sleep coaching sessions (eight sessions over 12 weeks: weekly for weeks 0-4 and biweekly for weeks 5-12) based on supportive accountability principles.
• The Healthy Living control group received health educational content via email and brief telephone contacts without counseling or goal setting.
• Primary outcomes included A1c, continuous glucose monitoring (CGM) parameters (time in range [TIR], time above range, time below range, and coefficient of variation [CV]), as well as objective sleep measures (sleep duration and variability via actigraphy). Outcomes were collected at baseline and 6, 12, and 24 weeks, and the primary endpoint was 12 weeks.

TAKEAWAY

• No significant differences in A1c or CGM parameters (TIR, time above range, time below range, and CV) were observed between the Sleep-Opt and Healthy Living groups at 12 weeks or any other timepoints in the overall sample.
• At 6 weeks, sleep duration increased within both groups: by 18.9 minutes in the Sleep-Opt group (95% CI, 9.3-28.5) and by 11.8 minutes in the Healthy Living group (95% CI, 1.4-22.2). However, no significant between-group differences were observed in sleep duration, variability, or regularity at any timepoint.
• Participants in the Sleep-Opt group demonstrated reduced diabetes distress (median difference, -0.18; 95% CI, -0.35 to -0.01) and improved subjective sleep quality (median difference, -0.96; 95% CI, -0.17 to -0.23) compared with the Healthy Living group at 6 weeks but not at 12 or 24 weeks.
• In participants with baseline A1c ≥ 7%, the Sleep-Opt group had lower A1c levels than the Healthy Living group at 12 weeks (marginal mean difference, -0.32%; 95% CI, -0.64% to -0.005%) and at 24 weeks (marginal mean difference, -0.44%; 95% CI, -0.73% to -0.14%).

IN PRACTICE

“Glycemic benefits were observed in participants with suboptimal A1c, suggesting a possible role of sleep intervention in this patient group,” the authors of the study wrote.

SOURCE

The study was led by Pamela Martyn-Nemeth, PhD, University of Illinois Chicago, Chicago. It was published online in Diabetes Care.

LIMITATIONS

The frequency of the coaching session dropped from weekly to biweekly after week 4, which may explain why sleep and distress improved by week 6 but then faded. The intermittent nature of data collection for both sleep and CGM may have missed changes occurring between timepoints. The study participants were well educated and entered with an at-goal average A1c (6.7%), which is not representative of individuals with T1D in general.

DISCLOSURES

This study received support from the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institutes of Health, and the University of Illinois Chicago. No relevant conflicts of interest were reported by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.