Relationship between sleep disturbance and self-care in adults with type 2 diabetes



Type 2 diabetes (T2D) is a metabolic disorder requiring intensive self-care to maintain optimal glycemic control. Sleep disturbance is common in T2D patients and likely impairs glycemic control. Our aim was to examine the relationship between sleep disturbance and self-care in adults with T2D.


This study used a correlational design. Sixty-four adults with T2D were recruited. Validated instruments were used to measure self-care, subjective sleep disturbance, and covariates (e.g., diabetes distress, self-efficacy, fatigue, and daytime sleepiness). Over an 8-day period, the ActiGraph-wGT3X was used to measure objective sleep outcomes (e.g., total sleep time and number of awakenings). Bivariate correlation and multiple linear regression analyses were conducted.


The mean age of the participants was 60.6 (SD 6.8) years (range 50–78), and 51.6% were women. Controlling for covariates, subjective sleep disturbance (β = − 0.26), diabetes distress (β = − 0.39), and daytime sleepiness (β = − 0.21) were strong predictors of diabetes self-care (R2 = 0.51, p < 0.001). When objective sleep parameters were used, the number of awakenings (β = − 0.23) also predicted self-care along with diabetes distress, fatigue, and daytime sleepiness (R2 = 0.57, p < 0.001).


Subjective sleep disturbance and frequent nocturnal awakenings are associated with worse diabetes self-care in adults with T2D. Healthcare providers are recommended to include comprehensive sleep assessment at every clinical visit. Diabetes educators may consider including sleep-related education in their diabetes self-management classes and/or counseling sessions.

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This research was supported by the Midwest Roybal Center for Health Promotion and Translation from the National Institute on Aging (Grant# P30AG022849). This research was also supported by the Institute for Health Research and Policy Grant support [Center for Clinical and Translational Science (CCTS) UL1RR029879], the Chancellor’s Graduate Research Award, and the Provost Award for Graduate Research of the University of Illinois at Chicago. This research was also supported by the National Institutes of Health/National Institute for Nursing Research and Department of Veterans Affairs, Research Career Scientist Award (EC) [K99 R00 NR012219 (CF)].


The funding source had no role in the design, data collection, analysis or interpretation of the study or in the decision to submit the manuscript for publication. We thank all participants for participating in this research.

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Correspondence to Cynthia Fritschi.

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All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Zhu, B., Quinn, L., Kapella, M.C. et al. Relationship between sleep disturbance and self-care in adults with type 2 diabetes. Acta Diabetol 55, 963–970 (2018).

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  • Actigraphy
  • Nocturnal awakening
  • Self-care
  • Sleep
  • Symptom
  • Type 2 diabetes