Aims: Individuals with type 2 diabetes (T2DM) are advised to undertake diabetes self-care behavior (DSCB) in order to avoid complications of T2DM. However, comorbidities, such as insomnia symptoms which are commonly reported in people with T2DM, may limit the ability to engage in DSCB. Insomnia and the common sequelae accompanying insomnia such as pain, depression, and anxiety may negatively influence the performance of DSCB. Therefore, this study aimed to compare the DSCB of people with T2DM with and without insomnia symptoms.
Methods: Sixty participants with T2DM were divided into two groups based on the presence of insomnia symptoms: T2DM-only group and T2DM+ insomnia group. Insomnia symptoms were identified using the Insomnia Severity Index (ISI). DSCB was assessed using the Diabetic Care Profile (DCP). A standardized composite score was established to account for all of the DCP domains. Chi-square and independent sample t tests were used to assess between-group differences in categorical and continuous variables, respectively. Stepwise linear regression analysis used the ISI score to predict standardized DCP composite score, while controlling for covariates.
Results: Significant between-group differences were found in age, symptoms of pain, depression, and anxiety. The total DCP composite score was significantly lower in the T2DM+ insomnia group compared to the T2DM-only group (- 0.30 ± 0.46 vs. 0.36 ± 0.48, respectively, p < 0.001) with large effect size (g = 1.40). Stepwise linear regression results showed that a 1-point increase in ISI score significantly predicted a .03-point decrease in standardized DCP composite score, after controlling for age, symptoms of pain, depression, and anxiety (β = - 0.03, p = 0.04).
Conclusions: The data suggest that people with T2DM and insomnia symptoms had worse scores on the majority of the DSCB domains and a worse DCP composite score compared to people with T2DM only. The data suggest a negative association between insomnia severity and DSCB among people with T2DM. Further research using a larger sample size and more rigorous research design is required to examine the causal relationship between insomnia symptoms and DSCB.
Keywords: Composite score; Diabetes self-care behavior; Diabetic Care Profile; Insomnia; Self-care; Type 2 diabetes.