Sleep Optimization to Improve Glycemic Targets in Adults With Type 1 Diabetes: A Randomized Controlled Parallel Intervention Trial

OBJECTIVE: To investigate the effects of a sleep intervention (Sleep-Opt) compared with an attention control intervention (Healthy Living) on glycemic targets and psychological outcomes in adults with type 1diabetes (T1D). RESEARCH DESIGN AND METHODS: Adults with T1D and short (<6.5 h/night) or irregular (variability of sleep duration ≥1 h) sleep were randomly assigned to either the Sleep-Opt (n = 73) or Healthy Living control (n = 71) intervention, both of which were remotely delivered in eight sessions for 12 weeks. Primary (A1C, continuous glucose monitoring [CGM], and objective sleep) and secondary (psychological and subjective sleep) outcomes were collected at baseline and 6, 12, and 24 weeks, with 12 weeks being a primary end point. RESULTS: A1C and CGM parameters at 12 weeks indicated no significant differences between groups. Sleep duration increased at 6 weeks in both groups, but no significant differences were observed between groups at any time point. Sleep-Opt participants had reduced diabetes distress (median difference -0.18 [95% CI -0.35, -0.01]) and improved subjective sleep quality (-0.96 [-0.17, -0.23]) compared with the Healthy Living group at 6 weeks but not at other time points. A significant interaction was found suggesting the effect of the intervention depended on baseline A1C level. At 12 weeks, the Sleep-Opt group with baseline A1C ≥7% had a lower A1C level than the Healthy Living group (marginal mean -0.32% [95% CI -0,64%, -0.005%]; -3.5 [95% CI -7.0, -0.1] mmol/mol; P = 0.047). CONCLUSIONS: Sleep-Opt did not improve glycemic targets or sleep parameters, although sleep improved in both intervention groups. Glycemic benefits were observed in participants with suboptimal A1C, suggesting a possible role of sleep intervention in this patient group.