Insomnia is highly prevalent in individuals with type 2 diabetes (T2D) and is associated with poor glycemic control. Louisiana has one of the highest diabetes prevalence rates in the U.S., with significant disparities by race, income, and rural residence. Despite growing recognition of sleep's role in diabetes management, sleep disturbances remain largely unaddressed in diabetes care. Cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for chronic insomnia, yet it is underutilized in primary care clinics such as federally qualified health centers (FQHCs) that serve high-risk populations. The long-term goal of this research is to improve cardiometabolic health and reduce diabetes disparities by integrating sleep interventions into diabetes care. This pilot study aims to: (1) evaluate the impact of CBT-I on sleep and diabetes-related outcomes, and (2) assess the acceptability, feasibility, and fidelity of implementing a 6-week CBT-I program in an FQHC setting. The investigators will conduct a randomized controlled trial (RCT) with 30 FQHC patients (aged 40+) with uncontrolled T2D (HbA1c \>7%) and comorbid insomnia (Insomnia Severity Index (ISI) score ≥15). Participants will be randomly assigned to either the CBT-I intervention or usual care. Sleep (ISI scores, actigraphy) and cardiometabolic (HbA1c, fasting glucose, insulin) outcomes will be assessed at baseline and three months post-randomization. Implementation success will be evaluated using fidelity, feasibility, and acceptability measures. Findings will provide preliminary evidence for integrating CBT-I into primary care, informing larger trials to improve diabetes outcomes and reduce disparities in Louisiana.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
30
6 weekly sessions delivered by a Sleep Coaching Team comprised of a federally qualified health center behavioral health provider and a health coach, focusing on stimulus control, sleep restriction, and cognitive therapy
Usual clinical care for management of diabetes (may include pharmacological and non-pharmacological approaches as determined by provider and patient)
Usual clinical care for treatment of insomnia (may include pharmacological and non-pharmacological approaches as determined by provider and patient)
Southeast Community Health Systems
Zachary, Louisiana, United States
Between-group difference in change in HbA1c from baseline to 3 months
Difference between intervention and usual care groups in change in hemoglobin A1c (HbA1c) from baseline to 3 months
Time frame: 3 months
Between-group difference in change in insomnia symptoms from baseline to 3 months
Difference between intervention and usual care groups in change in Insomnia Severity Index (ISI) score from baseline to 3 months. The ISI is a 7-item questionnaire with scale score ranging from 0 to 28, with higher scores indicating more insomnia symptoms.
Time frame: 3 months
Between-group difference in change in fasting glucose from baseline to 3 months
Difference between intervention and usual care groups in change in fasting glucose from baseline to 3 months
Time frame: 3 months
Between-group difference in change in concentration of insulin from baseline to 3 months
Difference between intervention and usual care groups in change in concentration of insulin from baseline to 3 months
Time frame: 3 months
Between-group difference in change in sleep efficiency from baseline to 3 months
Difference between intervention and usual care groups in change in sleep efficiency from baseline to 3 months. Sleep efficiency will be calculated from wearable device data as the percent of time in bed spent asleep.
Time frame: 3 months
Between-group difference in change in wake after sleep onset (WASO) from baseline to 3 months
Difference between intervention and usual care groups in change in wake after sleep onset (WASO) from baseline to 3 months. WASO will be calculated from wearable device data as the number of minutes spent awake after first sleep onset.
Time frame: 3 months
Between-group difference in proportion without clinical insomnia symptoms at 3 months
Difference between intervention and usual care groups in proportion with Insomnia Severity Index (ISI) score \<15 at 3 months. The ISI is a 7-item questionnaire with scale score ranging from 0 to 28, with higher scores indicating more insomnia symptoms. An ISI score \>= 15 indicates symptoms consistent with clinical insomnia.
Time frame: 3 months
Between-group difference in change in insomnia symptoms from baseline to 6 weeks
Difference between intervention and usual care groups in change in Insomnia Severity Index (ISI) score from baseline to 6 weeks. The ISI is a 7-item questionnaire with scale score ranging from 0 to 28, with higher scores indicating more insomnia symptoms.
Time frame: 6 weeks
Between-group difference in change in sleep efficiency from baseline to 6 weeks
Difference between intervention and usual care groups in change in sleep efficiency from baseline to 6 weeks. Sleep efficiency will be calculated from wearable device data as the percent of time in bed spent asleep.
Time frame: 6 weeks
Between-group difference in change in wake after sleep onset (WASO) from baseline to 6 weeks
Difference between intervention and usual care groups in change in wake after sleep onset (WASO) from baseline to 6 weeks. WASO will be calculated from wearable device data as the number of minutes spent awake after first sleep onset.
Time frame: 6 weeks
Between-group difference in proportion without clinical insomnia symptoms at 6 weeks
Difference between intervention and usual care groups in proportion with Insomnia Severity Index (ISI) score \<15 at 6 weeks. The ISI is a 7-item questionnaire with scale score ranging from 0 to 28, with higher scores indicating more insomnia symptoms. An ISI score \>= 15 indicates symptoms consistent with clinical insomnia.
Time frame: 6 weeks
Between-group difference in change in glucose time-in-range from baseline to 3 months
Difference between intervention and usual care groups in change in glucose time-in-range from baseline to 3 months. Time-in-range will be calculated from continuous glucose monitoring data as the percent of time spent in the range \>= 70 mg/dL and \<=180 mg/dL.
Time frame: 3 months
Between-group difference in change in glucose time-in-range from baseline to 6 weeks
Difference between intervention and usual care groups in change in glucose time-in-range from baseline to 6 months. Time-in-range will be calculated from continuous glucose monitoring data as the percent of time spent in the range \>= 70 mg/dL and \<=180 mg/dL.
Time frame: 6 weeks
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