Research Goals: To examine the role of treatment of insomnia on diabetes self-management behavior, symptom management (i. e. sleepiness and fatigue), and glucose control in adults with type 2 diabetes. Data from this study will help inform a randomized clinical trial that will test a behavioral sleep intervention in this population. The long-term goal of this program of research is determine the effect of sleep disorders as a barrier to self-management and quality of life in populations with at risk for impaired health and well being and to develop behavioral interventions to improve symptoms and self-management. Career Development Goals: There are two career development goals: 1) to increase the applicant's knowledge and expertise in behavioral sleep medicine and 2) to provide sufficient time and increase skills as an effective mentor of doctoral students, postdoctoral fellows, and junior faculty. Research Project: Recent evidence supports that insomnia is a prevalent problem among persons with type 2 diabetes that may be associated with increased daytime sleepiness and fatigue, increased diabetes-related distress, decreased self-management behavior, and worse glycemic control. The main hypothesis of the current application is that a web-based cognitive behavioral treatment of insomnia (SHUTi) in persons with T2DM will not only improve their nighttime sleep, but also improve their ability to integrate diabetes education into their daily behavior and positively affect their glucose control compared to a web-based Information Control group.
The aims of this study are to 1) obtain preliminary data to facilitate further hypothesis development and enhance the feasibility of conducting a randomized clinical trial to examine if treatment of insomnia results in participant's being better able to integrate diabetes education into their self-management behavior and result in improved glucose control, 2) explore the associations among changes in insomnia severity, fatigue, daytime sleepiness, sleep quality, A1C and DSM behaviors, 3) explore average pre-intervention to post-intervention changes in insomnia severity, daytime symptoms (fatigue, sleepiness, mood) and DSM behaviors (diet and physical activity) in subjects treated with SHUTi + DSM compared to IC + DSM subjects at 3 months, and 4) explore sleep fragmentation as a potential physiological mechanism linking impaired glucose control (A1C) and sleep in subjects with insomnia and T2DM at baseline and 3 months. The proposed application is relevant to NINR's mission to: 1) support development of beginning and midcareer scientists, 2) to improve symptom science to reduce the effect of disordered sleep and prevent symptoms of illness and 3) improved the science of self- management by the development of innovative approaches to reduce barriers to the self-management of chronic disease.
While previous studies suggest that obstructive sleep apnea co-exists with type 2 diabetes and that treatment may improve glucose control, there is no information on the effect of treatment of insomnia in persons with type 2 diabetes. The study will collect pilot data on the effect of a web-based cognitive-behavioral intervention for insomnia combined with diabetes education on self-care management behavior and glucose control. The study will (1) explore the associations among changes in insomnia severity, fatigue, daytime sleepiness, sleep quality, A1C and DSM behaviors; (2) changes in glucose control, insomnia severity, daytime symptoms and DSM behaviors in subjects treated for insomnia compared those in the information control group; and 3) explore sleep fragmentation as a potential physiological mechanism linking impaired glucose control and sleep in subjects with insomnia and T2DM. In addition, the application will support the mentoring of a cadre of junior nurse researchers who potentially can dramatically accelerate the application of sleep research to diverse populations to improve symptoms and empower patient's self-care management.
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