The effect of cognitive behavioral therapy for sleep and glycemic outcomes in people with diabetes: A systematic review and meta-analysis.

Abstract

Sleep disturbances are highly prevalent in individuals with diabetes and are associated with various adverse physiological, psychological, and social consequences. A growing body of research supports the effectiveness of cognitive behavioral therapy (CBT) in managing sleep problems in diabetes. However, the extent of its positive correlation with sleep quality and glycemic outcomes remains unclear due to the lack of rigorous evidence synthesis. Ten databases (PubMed, Cochrane Library, EMBASE, CINAHL, Web of Science, MEDLINE, APA PsycInfo, China National Knowledge Infrastructure [CNKI], Wanfang Data Knowledge Service Platform, VIP) were searched using keywords related to cognitive behavioral therapy and diabetes, from their inception until June 2026, to identify eligible randomized controlled trials. Researchers independently screened and extracted data from the included studies. The risk of bias was assessed using the Cochrane Risk of Bias tool (RoB 2.0). Random-effects meta-analyses were performed using Review Manager software (RevMan) 5.4.1 to estimate overall effects and for prespecified subgroup analyses. Sensitivity analysis, assessment of publication bias, and meta-regression were conducted using STATA 17.0 to explore study-level variables potentially contributing to heterogeneity. Ten eligible randomized controlled trials involving a total of 2827 participants from 4 countries were included in this synthesis. When comparing CBT to usual care or health education, CBT demonstrated a significant effect size for improving sleep quality (mean difference [MD] = -1.47; 95% confidence interval [CI] = -1.98 to -0.96; P < .00001; I2 = 89%). Significant improvements were also observed for glycemic outcomes (HbA1c: MD = -0.35%; 95% CI = -0.44 to -0.25; P < .00001; I2 = 94%) and insomnia severity (MD = -2.06; 95% CI = -4.24 to 0.12; P = .004; I2 = 88%). However, there was no significant improvement in BMI (MD = -0.12; 95% CI = -0.72 to 0.48; P = .69; I2 = 0%). Exploratory subgroup analyses revealed significant differences based on follow-up time. Through meta-regression, disease type, sample size, and intervention plan were not found to be sources of heterogeneity. Cognitive behavioral therapy significantly improves sleep quality, reduces HbA1c levels, and alleviates insomnia severity in people with diabetes. Future high-quality research is needed to optimize protocols, define target populations, and facilitate wider clinical implementation.