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

Acta Diabetol. 2018 Sep;55(9):963-970. doi: 10.1007/s00592-018-1181-4. Epub 2018 Jun 21.


Aims: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Keywords: Actigraphy; Nocturnal awakening; Self-care; Sleep; Symptom; Type 2 diabetes.

MeSH terms

  • Actigraphy
  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Glucose / metabolism
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / epidemiology*
  • Diabetes Mellitus, Type 2 / physiopathology
  • Diabetes Mellitus, Type 2 / therapy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Self Care* / standards
  • Self Efficacy
  • Sleep / physiology
  • Sleep Wake Disorders / complications
  • Sleep Wake Disorders / epidemiology*


  • Blood Glucose