Using Cognitive Behavioral Therapy for Insomnia in People with Type 2 Diabetes, Pilot RCT Part I: Sleep and Concomitant Symptom

Alshehri, Mohammed M.; Alenazi, Aqeel M.; Alothman, Shaima; Rucker, Jason; Phadnis, Milind A.; Miles, John M.; Siengsukon, Catherine; Kluding, Patricia M.

doi:10.1080/15402002.2020.1831501

Cited by 11 publications

(29 citation statements)

References 62 publications

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“…These symptoms included sadness, past failure, punishment or guilt feelings, crying, lack of interest, pessimism, agitation, worthlessness, indecision, sleeping patterns variations, loss of pleasure, appetite changes, self-dislike, lack of energy, irritability, loss of interest in sex and fatigue or tiredness in females [19][20] . One study in T2DM patients with concomitant chronic renal disease indicated that some of the depression symptoms such as sleep pattern disturbance, loss of energy, lack of interest in intercourse and fatigue or tiredness can occur more frequently [21][22] .…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Depression among Patients with Type-1 and Type-2 Diabetes Mellitus

Mumtaz¹,

Sarfraz²,

Musharraf³

et al. 2023

PJMHS

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The diabetic patients are more likely to experience depression. The study's objective was to determine the depression prevalence in newly diagnosed patients with type-I (T1DM) and type-II (T2DM) diabetes, as well as the relationship between these symptoms and several independent clinical and sociodemographic variables. Place and Duration: Study took place in the Department of Endocrinology and metabolism in Services Hospital Lahore, Pakistan for six months of duration from January 2017 to June 2017. Methods: A total of 320 patients included in the study, including two control groups of 180 people without diabetes and 75 patients in each group with T1DM and T2DM. The clinical, biochemical and sociodemographic characteristics of the patients were assessed and Beck Depression Inventory (BDI) was used to assess the symptoms of depression among patients. The association between the scores of BDI and independent factors such age, sex, mean arterial pressure, diabetes duration, BMI, diabetic complications and HbA1c level were assessed in the logistic regression analysis. Results: Compared to controls, females and males with T1DM and T2DM had significantly higher mean BDI scores. Females had depression symptoms more frequently than males diagnosed with diabetes mellitus. Patients with T1DM reported depressive symptoms among 20% of females and 5.7% of males, whereas those with T2DM have depression among 40.6% of women and 23.2% of men. The depression increased with age in patients with T1DM and T2DM, their HbA1c level rises, and they experience more complications. Women with T2DM also have a three-fold high risk of developing depressive symptoms than males. Conclusion: In conclusion, diabetic patients are more likely to experience depression in comparison to non-diabetics. 13.3% of T1DM patients and 30.7% of the T2DM patients having depressive symptoms. HbA1c level, age and the occurrence of comorbidities all raise the risk of depression in both T1DM and T2DM, and in T2DM depression is gender -specific. Keywords: Depressive symptoms, Beck Depression Inventory, type I and type II diabetes mellitus.

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Section: Discussionmentioning

confidence: 99%

Prevalence of Depression among Patients with Type-1 and Type-2 Diabetes Mellitus

Mumtaz¹,

Sarfraz²,

Musharraf³

et al. 2023

PJMHS

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“…An elegant meta-analysis by Kothari et al [ 44 ] identified six studies showing that cognitive behavioural therapy for insomnia (CBT-I) and/or sleep education improved sleep quality measured by the Pittsburgh Sleep Quality Index (−1.31 [95% CI −1.83, −0.80]) and resulted in a non-significant HbA 1c reduction (−3.6 mmol/mol [−0.35%]; p = 0.13) in those with sleep disturbances or insomnia, including both the general population and people with type 2 diabetes. Only two small pilot studies on CBT-I in people with type 2 diabetes have been conducted, reporting a reduction in both HbA 1c levels after 3 weeks (2.8 ± 3.06 mmol/mol [0.26 ± 0.28%]) [ 63 ] and after 7 weeks (4.5 mmol/mol [0.41%]; p = 0.01) [ 64 ], as well as a 4.63 ( p = 0.002) decrease in Beck Depression Inventory measures [ 65 ] in the latter cohort. The fact that CBT-I can effectively reduce depressive symptoms has been demonstrated previously outside this specific type 2 diabetes population [ 66 ].…”

Section: Treating Sleep Disorders In Type 2 Diabetesmentioning

confidence: 99%

“…These results suggest that weight loss, regardless of how the weight loss was induced, could be a successful treatment for OSA and type 2 diabetes. Only two small pilot studies on CBT-I in people with type 2 diabetes have been conducted, reporting a reduction in both HbA 1c levels after 3 weeks (2.8 ± 3.06 mmol/mol [0.26 ± 0.28%]) [63] and after 7 weeks (4.5 mmol/mol [0.41%]; p = 0.01) [64], as well as a 4.63 (p = 0.002) decrease in Beck Depression Inventory measures [65] in the latter cohort. The fact that CBT-I can effectively reduce depressive symptoms has been demonstrated previously outside this specific type 2 diabetes population [66].…”

Section: Non-pharmacological Treatmentmentioning

confidence: 99%

Sleep disorders in people with type 2 diabetes and associated health outcomes: a review of the literature

et al. 2021

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Sleep disorders are linked to development of type 2 diabetes and increase the risk of developing diabetes complications. Treating sleep disorders might therefore play an important role in the prevention of diabetes progression. However, the detection and treatment of sleep disorders are not part of standardised care for people with type 2 diabetes. To highlight the importance of sleep disorders in people with type 2 diabetes, we provide a review of the literature on the prevalence of sleep disorders in type 2 diabetes and the association between sleep disorders and health outcomes, such as glycaemic control, microvascular and macrovascular complications, depression, mortality and quality of life. Additionally, we examine the extent to which treating sleep disorders in people with type 2 diabetes improves these health outcomes. We performed a literature search in PubMed from inception until January 2021, using search terms for sleep disorders, type 2 diabetes, prevalence, treatment and health outcomes. Both observational and experimental studies were included in the review. We found that insomnia (39% [95% CI 34, 44]), obstructive sleep apnoea (55–86%) and restless legs syndrome (8–45%) were more prevalent in people with type 2 diabetes, compared with the general population. No studies reported prevalence rates for circadian rhythm sleep–wake disorders, central disorders of hypersomnolence or parasomnias. Additionally, several cross-sectional and prospective studies showed that sleep disorders negatively affect health outcomes in at least one diabetes domain, especially glycaemic control. For example, insomnia is associated with increased HbA1c levels (2.51 mmol/mol [95% CI 1.1, 4.4]; 0.23% [95% CI 0.1, 0.4]). Finally, randomised controlled trials that investigate the effect of treating sleep disorders in people with type 2 diabetes are scarce, based on a small number of participants and sometimes inconclusive. Conventional therapies such as weight loss, sleep education and cognitive behavioural therapy seem to be effective in improving sleep and health outcomes in people with type 2 diabetes. We conclude that sleep disorders are highly prevalent in people with type 2 diabetes, negatively affecting health outcomes. Since treatment of the sleep disorder could prevent diabetes progression, efforts should be made to diagnose and treat sleep disorders in type 2 diabetes in order to ultimately improve health and therefore quality of life. Graphical abstract

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“…The teleCBT-I intervention was based on a standard manual implemented by a co-investigator in previous and ongoing clinical trials (R01AG058530). [35][36][37] The intervention consisted of the standard components of CBT-I including time in bed restriction, stimulus control, sleep hygiene education, and cognitive therapy. Because hot flashes and night sweats commonly are reported in men with prostate cancer on ADT, 7,8 the CBT-I program was tailored to this patient group by emphasizing mindfulness and relaxation techniques, which have been shown to be effective interventions to reduce the frequency of and related patient-reported distress for night sweats and hot flashes.…”

Section: N Interventionmentioning

confidence: 99%

“…The co-investigator met regularly with the advanced practice oncology nurse throughout the study to discuss participants’ progress, answer questions, and ensure intervention fidelity. The teleCBT-I intervention was based on a standard manual implemented by a co-investigator in previous and ongoing clinical trials (R01AG058530) 35–37 . The intervention consisted of the standard components of CBT-I including time in bed restriction, stimulus control, sleep hygiene education, and cognitive therapy.…”

Section: Interventionmentioning

confidence: 99%

Androgen Deprivation and Sleep Disturbance

et al. 2022

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BackgroundMen receiving androgen deprivation therapy (ADT) for prostate cancer (PC) are at risk for cardiovascular comorbidities and cognitive changes. Interventional research involves in-person assessment of physical fitness/activity and cognitive function, which has been negatively affected by the COVID-19 pandemic. Androgen deprivation therapy–related hot flashes and nocturia increase risk for insomnia. Insomnia is associated with fatigue and may exacerbate ADT-related cognitive changes.ObjectivesThe purpose of this mixed-methods pilot was to (1) determine feasibility/acceptability of remotely assessing physical fitness/activity, cognitive function, and sleep; (2) deliver telehealth cognitive behavioral training for insomnia (teleCBT-I) to improve sleep; and (3) garner qualitative feedback to refine remote procedures and teleCBT-I content.MethodsFifteen men with PC receiving ADT completed a 4-week teleCBT-I intervention. Videoconferencing was used to complete study assessments and deliver the weekly teleCBT-I intervention.ResultsSelf-report of sleep quality improved (P < .001) as did hot flash frequency (P = .04) and bother (P = .025). Minimal clinically important differences were detected for changes in insomnia severity and sleep quality. All sleep logs indicated improvement in sleep efficiency. Remote assessment of fitness/cognitive function was demonstrated for 100% of participants. Sufficient actigraph wear time allowed physical activity/sleep assessment for 80%. Sleep actigraphy did not demonstrate significant changes.ConclusionsRemote monitoring and teleCBT-I are feasible/acceptable to men with PC on ADT. Further research to confirm teleCBT-I efficacy is warranted in this population.Implications for PracticePreliminary efficacy for teleCBT-I interventions was demonstrated. Remote assessments of physical fitness/activity, sleep, and cognitive function may enhance clinical trial access for rural or economically disadvantaged PC survivors.

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Using Cognitive Behavioral Therapy for Insomnia in People with Type 2 Diabetes, Pilot RCT Part I: Sleep and Concomitant Symptom

Cited by 11 publications

References 62 publications

Prevalence of Depression among Patients with Type-1 and Type-2 Diabetes Mellitus

Prevalence of Depression among Patients with Type-1 and Type-2 Diabetes Mellitus

Sleep disorders in people with type 2 diabetes and associated health outcomes: a review of the literature

Androgen Deprivation and Sleep Disturbance

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