Poor Sleep Linked to Greater Diabetes Distress in Adults with Type 2 Diabetes

A new study showed sleep impairment was linked to increased diabetes distress among adults with type 2 diabetes.1

“The results of this population-based cross-sectional study of people with [type 2 diabetes] demonstrate that sleep impairment is significantly associated with high diabetes distress, even after considering sociodemographic status, BMI, current use of insulin and depression as confounders,” wrote investigators, led by Hilde K. R. Riise, PhD, from the department of health and caring sciences at Western Norway University of Applied Sciences.1

Type 2 diabetes can put people at risk for many life-threatening events—myocardial infarction, stroke, heart failure, kidney failure, and painful diabetic neuropathy. With all the risks involved, diabetes can negatively impact someone’s psychological well-being, resulting in diabetes distress.

About 40% of adults with either type 1 or type 2 diabetes report significant distress, and the frequent worrying about managing their disease can impact diet, exercise, medication adherence, and glycemic control.2 Diabetes distress should not be mistaken for clinical depression; if a patient feels very depressed or sad, they should seek out a mental health professional.

Several factors have been linked to high diabetes distress, including female sex, poor glycemic control, short diabetes duration, and comorbid depressive symptoms. However, there may be another factor—sleep.1

People with diabetes often have poor sleep, resulting in inadequate glycemic control. Obstructive sleep apnea (OSA) and insomnia are common sleep disorders in patients with type 2 diabetes.

Studies have previously reported the link between sleep impairment and high diabetes stress, but focused on adolescents and young adults with type 1 diabetes, and led to conflicting results.3,4 One study showed daytime sleepiness are associated with diabetes distress in patients with type 2 diabetes.5 Another study found adults with type 1 or 2 diabetes who reported sleep impairments were more likely to experience diabetes distress.6

Sleep problems may contribute to diabetes distress by worsening fatigue and psychological distress due to reduced insulin sensitivity, raising HbA1c levels and impairing glycemic control, and hindering cognitive function needed for diabetes management. Poor sleep can also strain social interactions and increase feelings of isolation, further elevating distress.

Despite the research out there supporting the link between sleep impairment and diabetes distress, not enough evidence exists to establish this association in people with type 2 diabetes. Investigators recognized that identifying modifiable risk factors for diabetes distress, such as short sleep duration, disrupted sleep, and misaligned circadian rhythm, may improve self-management and glycemic control. In HUNT, a population-based, cross-sectional study, the team sought to examine the associations between sleep impairments and diabetes distress.

The study included 1954 adults aged ≥ 20 years (mean age, 67.3 years) with type 2 diabetes who completed the 2017 – 2019 HUNT4 survey. The sample had 837 women and 1117 men.

The sleeping HUNT-Questionnaire measured snoring, sleep apnea, troubles falling asleep, waking up during the night, early wakening, restless legs, difficulties coping during the daytime due to sleep issues, and the number of hours respondents sleep a night. The Problem Areas in Diabetes (PAID-5) questionnaire measured diabetes distress.

The analysis showed sleep impairment was linked to increased diabetes distress. This association was seen across modifiable risk factors: ≤ 7 hours of sleep (0.6; 95% confidence interval [CI], 0.2 – 0.9), snoring (0.6; 95% CI, 0.1 – 1.1), trouble falling asleep (1.4; 95% CI, 0.8 – 22), waking up during the night (1.1; 95% CI, 0.6 – 1.6), early wakening (1.2; 95% CI, 0.7 – 1.8), trouble coping during daytime due to sleep problems (2.6; 95% CI, 1.7 – 3.6), and restless legs (0.8; 95% CI, 0.2 – 1.3).

The strong link between coping during daytime and high diabetes distress suggests that the consequences of sleep impairment, such as less energy, more irritability, and focusing problems, are driving diabetes distress.

“Understanding sources of sleep impairments in [type 2 diabetes] may lead to the development of interventions designed to improve sleep and, in turn, have a positive effect on diabetes self-management and psychological well-being,” investigators wrote. “We suggest that the assessment of sleep quality should be part of routine diabetes care in people with [type 2 diabetes]…the long-term effects of poor sleep on diabetes distress warrant further investigation.”

References

1. Riise HKR, Haugstvedt A, Igland J, et al. Diabetes distress and sleep impairment in type 2 diabetes: A population-based cross-sectional study-The HUNT Study, Norway. Diabet Med. Published online July 25, 2025. doi:10.1111/dme.70106

2. Learn about Diabetes distress. Diabetes Distress. https://diabetesdistress.org/learn-about-dd/. Accessed July 28, 2025.

3. Griggs S, Grey M, Ash GI, Li CR, Crawford SL, Hickman RL Jr. Objective Sleep-Wake Characteristics Are Associated With Diabetes Symptoms in Young Adults With Type 1 Diabetes. Sci Diabetes Self Manag Care. 2022;48(3):149-156. doi:10.1177/26350106221094521

4. Nefs G, Feinn R, Chang AM, Wagner J. Longitudinal relations of sleep quality with depressive symptoms, diabetes distress and self-efficacy in young people with type 1 diabetes. J Psychosom Res. 2023;173:111457. doi:10.1016/j.jpsychores.2023.111457

5. Gunn S, Henson J, Robertson N, et al. Self-compassion, sleep quality and psychological well-being in type 2 diabetes: a cross-sectional study. BMJ Open Diabetes Res Care. 2022;10(5):e002927. doi:10.1136/bmjdrc-2022-002927

6. Nefs G, Donga E, van Someren E, Bot M, Speight J, Pouwer F. Subjective sleep impairment in adults with type 1 or type 2 diabetes: Results from Diabetes MILES--The Netherlands. Diabetes Res Clin Pract. 2015;109(3):466-475. doi:10.1016/j.diabres.2015.07.008