Sleep disorders in people with type 2 diabetes and associated health outcomes: a review of the literature
Open accessAbstract
Abstract Sleep disorders are linked to development of type 2 diabetes and increase the risk of developing diabetes complications. Treating sleep disorders might therefore play an important role in the prevention of diabetes progression. However, the detection and treatment of sleep disorders are not part of standardised care for people with type 2 diabetes. To highlight the importance of sleep disorders in people with type 2 diabetes, we provide a review of the literature on the prevalence of sleep disorders in type 2 diabetes and the association between sleep disorders and health outcomes, such as glycaemic control, microvascular and macrovascular complications, depression, mortality and quality of life. Additionally, we examine the extent to which treating sleep disorders in people with type 2 diabetes improves these health outcomes. We performed a literature search in PubMed from inception until January 2021, using search terms for sleep disorders, type 2 diabetes, prevalence, treatment and health outcomes. Both observational and experimental studies were included in the review. We found that insomnia (39% [95% CI 34, 44]), obstructive sleep apnoea (55–86%) and restless legs syndrome (8–45%) were more prevalent in people with type 2 diabetes, compared with the general population. No studies reported prevalence rates for circadian rhythm sleep–wake disorders, central disorders of hypersomnolence or parasomnias. Additionally, several cross-sectional and prospective studies showed that sleep disorders negatively affect health outcomes in at least one diabetes domain, especially glycaemic control. For example, insomnia is associated with increased HbA1c levels (2.51 mmol/mol [95% CI 1.1, 4.4]; 0.23% [95% CI 0.1, 0.4]). Finally, randomised controlled trials that investigate the effect of treating sleep disorders in people with type 2 diabetes are scarce, based on a small number of participants and sometimes inconclusive. Conventional therapies such as weight loss, sleep education and cognitive behavioural therapy seem to be effective in improving sleep and health outcomes in people with type 2 diabetes. We conclude that sleep disorders are highly prevalent in people with type 2 diabetes, negatively affecting health outcomes. Since treatment of the sleep disorder could prevent diabetes progression, efforts should be made to diagnose and treat sleep disorders in type 2 diabetes in order to ultimately improve health and therefore quality of life. Graphical abstract
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Diabetes mellitus and hyperthyroidism may contribute to sleep disturbances through mechanisms such as nocturia, autonomic dysregulation, or association with comorbidities such as restless legs syndrome/Willis-Ekbom disease and obstructive sleep apnea.
“Diabetes mellitus and hyperthyroidism may contribute to sleep disturbances through mechanisms such as nocturia, autonomic dysregulation, or association with comorbidities such as restless legs syndrome/Willis-Ekbom disease and obstructive sleep apnea.”
From Z-drug abuse and dependence: Clinical guideline of the Brazilian Academy of Neurology for diagnosis and management (2025) · cites this paper as [57]
The “Possible mechanisms, clinical implications and future research” section says type 2 diabetes and associated conditions, including nocturia and increased sympathetic activity, may contribute to sleep disorders. It also reports higher prevalence of restless legs syndrome and obstructive sleep apnoea in people with type 2 diabetes. The paper does not address hyperthyroidism as a contributor to sleep disturbances. (LLM, conf=0.88)
Experimental — accuracy not yet measuredSleep disturbances are associated with less engagement in diabetes self-management among people with type 1 and type 2 diabetes.
“Moreover, sleep disturbances are associated with less engagement in diabetes self-management and may interfere with the achievement of glycemic targets among people with type 1 and type 2 diabetes (434-439).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:<i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [439]
Sleep disturbances may interfere with the achievement of glycemic targets among people with type 1 and type 2 diabetes.
“Moreover, sleep disturbances are associated with less engagement in diabetes self-management and may interfere with the achievement of glycemic targets among people with type 1 and type 2 diabetes (434-439).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:<i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [439]
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- Authors
- Schipper, S. B. J., Van Veen, M. M., Elders, P. J. M., van Straten, A., Van Der Werf, Y. D., Knutson, K. L., & Rutters, F.
- Affiliations
- Amsterdam Public Health (NL)
- University of Chicago (US)
- Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
- Corresponding author
- Rutters, Femke
- ORCID
- Venue
- Diabetologia
- Published
- 2021-08-16
- Volume
- 64
- Issue
- 11
- Pages
- 2367-2377
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- PMC
- PMC8494668
- OpenAlex
- W3195762401
- Cited by
- 202
- References
- 77
- Citations by year
- 2026: 37 · 2025: 61 · 2024: 41 · 2023: 44 · 2022: 19
- FWCI
- 4.26
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Diabetologia (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- VU Research Portal (publishedVersion, other-oa)
- Pure Amsterdam UMC (submittedVersion, cc-by)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- National Institutes of Health
- National Institute on Aging (R01AG059291)
- National Heart, Lung, and Blood Institute (R01HL141881)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- sleep disorders, type 2 diabetes, insomnia, obstructive sleep apnea, restless legs syndrome, glycemic control, HbA1c, diabetes complications, microvascular complications, macrovascular complications, depression, mortality, quality of life, cognitive behavioral therapy, sleep education, weight loss, diabetes progression
- MeSH terms
- Cross-Sectional Studies, Diabetes Mellitus, Type 2, Health Status Indicators, Humans, Sleep Initiation and Maintenance Disorders, Prospective Studies, Restless Legs Syndrome, Sleep Wake Disorders, Sleep Disorders, Circadian Rhythm, Sleep Apnea, Obstructive
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