By Amber Jackson, RN, DCES
Could getting better sleep get you a better A1C?
A recent randomized clinical trial published in Diabetes Care looked at whether targeted sleep coaching could improve glucose management in adults with T1D who had short or irregular sleep. The results weren’t universal, but for one important group, they were promising.
What Did the Study Do?
Researchers enrolled 144 adults with T1D who either slept less than 6.5 hours per night or had irregular sleep schedules. Participants were randomly assigned to either a sleep-optimization program (Sleep-Opt) or a general healthy-living control group.
The Sleep-Opt program included:
- A Fitbit sleep tracker
- A smartphone app with personalized feedback and educational content
- Individual telephone sleep coaching
- Eight coaching sessions over 12 weeks
- Strategies designed to improve sleep habits, consistency, and accountability
Researchers tracked A1c, CGM metrics, objective sleep measures, perceived sleep quality, and diabetes distress.
The Big Caveat: A1c Improvement Was NOT Seen in Everyone
When researchers looked at the entire group, sleep coaching did not significantly improve A1c, time in range, time above range, time below range or glucose variability compared with the control intervention.
That’s important.
However, when researchers looked specifically at participants who started the study with an A1c of 7% or higher, a different picture emerged.
Compared with the control group, those receiving sleep coaching had an A1c that was:
0.32% lower at 12 weeks
and
0.44% lower at 24 weeks.
That’s a meaningful difference from a behavioral intervention that didn’t involve adding another diabetes medication.
Why Might People With Higher A1cs Benefit More?
The study doesn’t establish the reason, so we have to be careful not to assume cause and effect.
One possibility is that individuals with higher A1cs may have had more modifiable barriers to glucose management, potentially including sleep quality, sleep habits, diabetes distress or the behavioral demands surrounding diabetes management.
Sleep and diabetes also interact in both directions. Poor sleep can make diabetes management harder, while glucose fluctuations, alarms, overnight hypoglycemia, hyperglycemia and the constant demands of T1D can make quality sleep harder to achieve.
Interestingly, the sleep intervention also produced short-term improvements in self-reported sleep quality and diabetes distress at six weeks, although these differences were no longer significant at 12 or 24 weeks.
It’s Not Just About Getting More Hours
Another interesting finding was that sleep duration increased somewhat in both groups, and researchers did not find significant differences between groups in objective sleep duration, variability or regularity.
That suggests the story may be more complicated than simply:
“Sleep 30 minutes longer and your A1c will drop.”
Sleep coaching may instead help certain individuals address the broader behaviors, routines and stress surrounding sleep and diabetes management.
Sleep May Be Another Piece of the Diabetes Puzzle
About 40% of adults with T1D don’t get enough sleep, according to the background research cited by the investigators. For someone already managing insulin dosing, glucose variability, food, exercise, stress and dozens of daily diabetes decisions, chronically poor or inconsistent sleep may be one more factor working against them.
This study doesn’t tell us that sleep coaching will lower A1c for everyone with T1D. In fact, it specifically tells us that the glycemic benefit was concentrated among participants whose starting A1c was 7% or higher.
But that’s exactly why the finding is interesting.
When glucose management isn’t where you want it to be, the answer may not always be more insulin adjustments. Sometimes it may be worth looking at the rest of your life—including how well you’re sleeping.
How Are You Sleeping?
If you’re struggling with glucose management, diabetes distress, inconsistent sleep, frequent nighttime waking or simply never feeling rested, sleep may be worth assessing as part of your overall diabetes care.
Contact an Integrated Diabetes Services clinician for more information about sleep assessment and individualized strategies for improving sleep quality while living with T1D.
*To learn more about the role of sleep in diabetes care and tricks to improve your sleep quality, check out the course “Sleep Your Way to Better Diabetes Management“ at www.type1university.com
Resources
Martyn-Nemeth P, et al. Sleep Optimization to Improve Glycemic Targets in Adults With Type 1 Diabetes. Diabetes Care. 2026;49(7):1270-1279. doi:10.2337/dc26-0273.
