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06-21-2018 | Sleep disorders | Article

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

Acta Diabetologica

Authors: Bingqian Zhu, Laurie Quinn, Mary C. Kapella, Ulf G. Bronas, Eileen G. Collins, Laurie Ruggiero, Chang G. Park, Cynthia Fritschi

Publisher: Springer Milan



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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