By Leslie Bienen, CHR Writer and Editor
Erin S. LeBlanc, MD, MPH
Could sleepless nights contribute to diabetes? Dr. Erin LeBlanc, a Senior Investigator at the Kaiser Permanente Center for Health Research (KP CHR), is leading a new study called Sleep for Health that seeks to answer that question. The study will test whether a sleep treatment called Cognitive Behavioral Therapy for Insomnia (CBT-I) results in lower blood sugar for people with prediabetes. LeBlanc and her team will spend the next five years collecting data on 300 people who have both prediabetes and insomnia. Participants will be randomly assigned to one of two groups: CBT-I or sleep education.
The study will answer three important questions. First, does treating insomnia with CBT-I lower people’s blood sugar levels more effectively than sleep education? Second, do sleep improvements in either group correlate with lower blood sugar? And third, are diet and mood important factors that may affect sleep improvement? The study will also store collected blood samples for future research related to sleep, prediabetes, and diabetes progression.
The number of people with Type 2 diabetes (T2D) and prediabetes is predicted to swell in the next few decades. Although it can be treated, T2D is a major cause of blindness, kidney failure, cardiovascular disease, amputations, reduced quality of life, lost years of work, and premature death in the U.S. An estimated one in three Americans will have T2D by 2050. The costs of undiagnosed and diagnosed diabetes are also staggeringly high, with recent estimates placing them at about 400 billion dollars annually.
Research shows that, among people with prediabetes, having insomnia is a risk factor for developing T2D, making this study critically important. While losing weight and exercising more are effective ways to prevent T2D, making those changes can be challenging. Improving sleep could be an important tool to add to the toolbox for diabetes prevention.
Insomnia is extremely common. Thirty percent of patients with prediabetes in the Kaiser Permanente Northwest health system have sought treatment for insomnia, a figure that is likely low given that insomnia is often undiagnosed. Chronic sleep loss and poor sleep quality are associated with eating more, weight gain, obesity, decreased physical activity, increased inflammation, and increased cortisol levels—all of which may increase risk of T2D. The Sleep for Health study will use an activity sensor and continuous glucose monitoring to understand how CBT-I affects impacts blood sugar as well as to collect data on sleep quality.
The insomnia treatment will be delivered through an online platform called SHUTi (“shut-eye”), which has been shown to improve sleep. Distinguished Investigator Greg Clarke and Senior Investigator Ning Smith, both from CHR, are part of the research team, as are investigators from KP Hawaii and KP Southern California.
Dr. LeBlanc is excited about this study’s potential to help us understand relationships between poor sleep and prediabetes and T2D. CBT-I is the most effective treatment for insomnia, and has no unpleasant side effects, as medications can have. If the Sleep for Health study shows this treatment to be beneficial, digital platforms can be scaled up quickly. The end goal is to add another preventive treatment option for the millions of people who have prediabetes and insomnia, to lower the number of Americans who go on to develop T2D.
The Sleep for Health Study is funded by the National Institute of Diabetes and Digestive and Kidney Diseases.