Digital Intervention Increasing Sleep Duration Among People With Type 2 Diabetes: Pilot Randomized Controlled Trial

Abstract

Introduction and objective:

Short sleep duration is associated with worse hemoglobin A_1c (HbA_1c), and treatment guidelines recommend sufficient sleep duration. However, it is unclear whether extending sleep duration of short-sleeping people with type 2 diabetes causes improved HbA_1c. We aimed to assess the effect on HbA_1c of increasing sleep duration.

Methods:

We developed a personalized digital intervention based on the theory of planned behavior and conducted a single-blind, two-arm randomized controlled trial with 70 short-sleeping (≤6 hours) people with type 2 diabetes in Japan. Both arms measured sleep duration using an actigraph and a sleep diary. The intervention group received bedtime advancement support, including achievable bedtime goal setting and feedback. The primary outcome was between-arm difference in HbA_1c change after 12 weeks.

Results:

The baseline average sleep duration and HbA_1c were 5.96 ± 1.26 (hours) and 8.30 ± 0.91 (%) in the intervention group, and 5.94 ± 0.96 (hours) and 8.09 ± 0.51 (%) in the control group, respectively. Sleep duration improved with statistical significance (between-arm difference in change: 32.8 minutes, P = .0042). However, HbA_1c did not reduce significantly (between-arm difference in change: –0.11%, P = .51), and increases in sleep duration were not significantly associated with HbA_1c reduction (P = .69).

Conclusion:

In this randomized trial, an average sleep extension of approximately 30 minutes over 12 weeks did not result in a significant improvement in HbA_1c among short-sleeping adults with type 2 diabetes. Further studies with larger sample sizes and greater sleep extension are warranted.