SUN-586 Effects of Cognitive Behavioral Therapy for Insomnia in Type 2 Diabetes Mellitus: A Randomized Control Trial

Abstract Disclosure: S. Kirisri: None. S. Reutrakul: None. C. Sriphrapradang: None. S. Tiensuntisook: None. N. Chirakalwasan: None. S. Saetung: None. C. Aonnuam: None. C. Areevut: None. R. Jerawatana: None. J. Siritienthong: None. Introduction: Sleep disturbances, including insomnia, are prevalent in individuals with type 2 diabetes (T2D) and are associated with adverse metabolic outcomes. Cognitive behavioral therapy for insomnia (CBTI) is an evidence-based treatment, but its effects on sleep and glycemic control in T2D remain unclear. This study evaluated the impact of CBTI on sleep quality, glycemic control, and sleep parameters in T2D patients with insomnia. Methods: Forty participants with non-insulin-treated T2D and insomnia were randomized to CBTI (n=20) or Health Education (HE; n=20). Both groups participated eight weekly, one-hour online sessions. Primary outcome was self-reported sleep quality (Pittsburgh Sleep Quality Index, PSQI). Secondary outcomes were self-reported sleep duration, insomnia symptoms , actigraphy-based sleep measures, glycemic control (A1C, fasting glucose), anxiety and depressive symptoms, and quality of life. Self-reported data were collected at baseline, 8 weeks (end of intervention), and 16 weeks, while actigraphy and glycemic control were collected at baseline at 8 weeks. Program satisfaction was collected at 16-weeks. Between-group differences were analyzed using multilevel mixed-effects linear regression and reported as mean difference with 95% confidence intervals (95% CI). Results: Participants in the CBTI and HE groups were 55.7±6.1 vs. 52.1±10.2 years old, and 65% vs. 70% were female, respectively. Primary outcome, self-reported sleep quality at 8-week, did not differ between groups but the CBTI group had significantly improved sleep regularity (fluctuations of sleep duration during the actigraphy recording period) compared to the HE group (mean difference -21.84 minutes (95% CI -41.64, -2.05, p=0.031). At 16 weeks, the CBTI group also had a greater reduction in anxiety symptoms than the HE group (p=0.039). No significant differences were observed in other self-reported or metabolic parameters. In the per-protocol analysis, including only participants who completed entire program (CBTI: n=15; HE: n=10), the CBTI group demonstrated greater improvement in self-reported sleep quality (p=0.042) at 16 weeks. At 8 weeks, there was a greater reduction in fasting glucose levels in the CBTI group as compared to the HE group (mean difference -34.27mg/dL [95% CI -55.16, -13.37], p=0.001) . Satisfaction ratings were high and comparable between groups (CBTI 4.4±0.5 vs. HE 4.5±0.4, p=0.707). Conclusion: CBTI was superior to health education in improving sleep regularity and reducing anxiety symptoms in T2D with insomnia. Adherence to CBTI also led to significant fasting glucose reductions, supporting its role in glycemic management. Sleep assessment and tailored insomnia interventions such as CBTI should be integrated into T2D standard care to optimize metabolic and sleep outcomes. Presentation: Sunday, July 13, 2025