A Systematic Review of Studies Investigating the Impact of Sleep Quality on Metabolic Variables in Individuals With T2DM

A Systematic Review of Studies Investigating the Impact of Sleep Quality on Metabolic Variables in Individuals With T2DM | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review A Systematic Review of Studies Investigating the Impact of Sleep Quality on Metabolic Variables in Individuals With T2DM Deniz TALAZ, Elem KOCAÇAL, Ezgi BAĞRIAÇIK This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6820219/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background This systematic review was conducted by including recent studies in the literature that examine the relationship between sleep quality and metabolic parameters in individuals with type 2 diabetes. Objectives The aim was to contribute to the literature by evaluating studies that investigate the impact of sleep quality on metabolic variables in individuals with type 2 diabetes. Methods Research indexed in international databases between 1995 and 2025 and meeting specified criteria was included. Sleep quality was assessed based on factors such as duration, continuity, sleep onset latency, and individual satisfaction with sleep. The studies were also analyzed and compared according to glycemic control variables (HbA1c levels), which are considered to be influenced by sleep. A total of 38 studies meeting the criteria were included after screening seven databases. Findings The findings indicate that insufficient and poor-quality sleep is generally associated with elevated HbA1c levels, impaired glucose tolerance, increased insulin resistance, and adverse lipid profiles. Furthermore, some studies have reported that sleep disorders may negatively affect the course of diabetes by contributing to increased inflammatory markers. Conclusion The findings suggest that sleep quality is an important lifestyle factor to consider in the management of type 2 diabetes. They also underscore the importance of healthcare professionals integrating sleep assessments and interventions into clinical practice for individuals with diabetes. Endocrinology & Metabolism Nursing Physical Medicine & Rehab Adults Metabolic variables Sleep quality Systematic review Type 2 diabetes Figures Figure 1 Figure 2 Introduction The prevalence of diabetes is steadily increasing both globally and in Turkey, with the incidence of type 2 diabetes (T2DM) rising rapidly, particularly in developed and developing countries [ 1 ]. In the adult population of Turkey, the prevalence of diabetes was reported as 7.2% in the Turkish Diabetes, Hypertension, Obesity and Endocrinological Diseases Prevalence Study-I (TURDEP-I) [ 2 ], whereas this rate increased to 13.7% in the TURDEP-II study [ 2 ]. Factors contributing to the increase in diabetes include longer life expectancy, lifestyle changes due to urbanization, physical inactivity, and dietary habits [ 3 ]. Moreover, inadequate sleep has also been identified as a risk factor for diabetes. A clinical review noted that the decline in average sleep duration in the United States of America (USA) coincided with the increased prevalence of diabetes and obesity [ 4 ]. Sleep is defined as an active physiological state involving sustained unresponsiveness to the external environment and dynamic changes in neurological, metabolic, and cardiorespiratory functions [ 5 ]. Although it varies by individual and age, the ideal sleep duration for adults is on average 7–8 hours [ 6 ]. Quality sleep is recommended to be timely, of sufficient duration, and uninterrupted [ 7 , 8 ]. However, due to current living conditions or physiological and psychological problems, sleep disorders have become a widespread concern [ 9 , 10 ]. Sleep disorders are characterized by disruptions in sleep patterns and refer to issues related to the quality, timing, and quantity of sleep. They include difficulties in falling asleep and maintaining sleep, falling asleep at inappropriate times, sleeping too much or too little, and exhibiting abnormal behaviors during sleep [ 11 ]. Over the past 50 years, daily sleep duration has decreased by 1.5 to 2 hours among adults and adolescents, and approximately one-third of Americans aged 30–64 are reported to sleep less than six hours a day [ 12 ]. Similar results have drawn attention in Turkey. According to the “National Sleep Epidemiology Study in the Adult Population,” which mapped Turkey’s sleep profile, 13% of people reported having difficulty falling asleep, 30% slept more than eight hours, and 11% slept less than six hours [ 13 ]. During sleep, changes occur in hormone levels that regulate body metabolism. Blood glucose levels and insulin concentrations are higher during nighttime sleep compared to daytime and nighttime wakefulness [ 14 , 15 ]. Glucose utilization is highest during wakefulness, lowest during Non-Rapid Eye Movement (NREM) sleep, and moderate during Rapid Eye Movement (REM) sleep; glucose tolerance is also lower throughout the night [ 14 ]. Growth hormone rises at the onset of sleep and reaches its peak level during slow-wave sleep (SWS). Cortisol levels significantly increase in the second half of sleep, predominantly during REM sleep [ 16 , 17 ]. Thyroid-stimulating hormone (TSH) secretion increases during nighttime sleep [ 18 ]. Leptin follows a circadian rhythm that peaks in the early phases of the sleep period [ 4 ], while circulating ghrelin concentrations also exhibit a peak at their maximum level during the night [ 19 ]. In sleep disorders, changes in neurohormonal functioning—such as increased sympathetic activity [ 20 – 24 ] and elevated cortisol levels [ 18 ], suppression of growth hormone [ 16 , 17 ] and TSH secretion [ 18 , 25 ], and reduced leptin secretion [ 21 ]—lead to obesity, hyperglycemia, and insulin resistance [ 26 – 28 ] (Fig. 1 ). As a result, diabetes, its micro- and macrovascular complications, hypoglycemia, neuropathic pain, diabetic foot ulcers, sleep apnea, and depression may also develop, further impairing sleep effectiveness and quality. Consequently, sleep influences the development of diabetes and its complications, while diabetes also impacts sleep [ 27 ]. Although sleep has been shown to be an important factor in blood glucose regulation, current guidelines for the follow-up and care of individuals with diabetes [ 29 , 31 ] do not include a focus on sleep. Therefore, the aim of this article is to highlight the relationship between diabetes—a chronic disease that is highly prevalent both globally and in our country, and requires continuous monitoring and care—and sleep, and to raise awareness of the importance of effective sleep in individuals with diabetes. This article will review topics such as glucose metabolism in the context of sleep and sleep disorders, the effects of diabetes on sleep, sleep from a nursing perspective, and will discuss the importance of evaluating the sleep patterns of diabetic patients. Aim This systematic review aims to evaluate studies investigating the effects of sleep and sleep disorders related to the disease on glucose metabolism in individuals with T2DM. Methods This systematic review was prepared according to the recommendations of the "Preferred Reporting Items for Systematic Review and Meta Analysis Protocols 2015 Statement (PRISMA-P)." Since the review was conducted by examining existing studies, ethical committee approval was not required for the study [ 32 ]. This systematic review was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD420251042052. The registered protocol, titled "Evaluation of Studies Examining the Effect of Sleep Quality on Metabolic Variables in Individuals with T2DM: A Systematic Review", outlines the objectives, eligibility criteria, and planned methodology for study selection, data extraction, and synthesis. Search Strategy For this systematic review, a search was conducted using the English keywords "sleep and diabetes, diabetes and sleep disorders, sleep in T2DM, sleep quality and Diabetes Mellitus, the importance of sleep in diabetes, the effect of sleep on diabetes and diabetes on sleep" without any year restrictions, from January 3, 2023, to March 25, 2025. The databases used for the search include Google Scholar, Medline/PubMed, Cochrane Library, Science Direct, CINAHL Complete, OVID, and Web of Science. The number of studies found was categorized by database and shown in the PRISMA flow diagram (Fig. 1 ). Inclusion Criteria The systematic review included studies that investigate the effects of sleep and sleep disorders related to the disease on glucose metabolism in individuals with T2DM. Only studies written in English, with full-text availability, and published in a review design were included. The studies included in the systematic review were selected based on the ‘P: Population (type of participants), participant characteristics; I: Intervention (types of interventions), intervention characteristics; C: Comparator (types of comparisons), comparison groups; O: Outcome (types of outcomes), outcomes; S: Study designs (types of studies), study design (PICOS) model recommended by the Joanna Briggs Institute [ 33 ]. P: Studies examining the effect of disease-related sleep and sleep disorders on glucose metabolism in individuals with T2DM, regardless of gender, race, and socio-economic status, were included in the review. I: Studies investigating the effects of disease-related sleep and sleep disorders on glucose metabolism in individuals with T2DM were reviewed. C: Studies discussing the effects of disease-related sleep and sleep disorders on glucose metabolism in individuals with T2DM, as well as the effectiveness of other interventions, were included. O: Parameters affecting glucose metabolism in individuals with T2DM due to sleep and sleep disorders were assessed. S: The studies included were randomized controlled trials, descriptive studies, and relational design research. Exclusion Criteria Studies reporting no results on the effect of disease-related sleep and sleep disorders on glucose metabolism in individuals with T2DM, as well as those outside the scope of randomized controlled trials, descriptive, and relational designs, were not included in this study. Study selection Studies were independently selected by the researchers. A total of 1452 studies from Google Scholar (n = 754), Medline/PubMed (n = 126), Cochrane Library (n = 587), Science Direct (n = 60), CINAHL Complete (n = 203), OVID (n = 115) and Web of Science (n = 107) were accessed as a result of an electronic search with keywords. From these articles, 38 studies were included in the systematic review after excluding those that they did not meet the inclusion criteria, had inappropriate titles and abstracts, were duplicated, or had inappropriate content (Fig. 1 ) Results As a result of searching the identified keywords and their synonyms, a total of 1452 studies were found from Google Scholar (754), PubMed/Medline (126), CINAHL Complete (203), Science Direct (60), Web of Science (107), Cochrane Library (87), and Ovid (115). After removing duplicate studies, studies with inappropriate titles and abstracts were excluded. The remaining 546 studies were re-evaluated according to inclusion and exclusion criteria. Based on this evaluation, 38 studies meeting the inclusion criteria were included in the study (Fig. 1 ). The findings obtained from the detailed analysis of the 38 studies included in the systematic review (as shown in Table 1 ) were evaluated under 9 headings: research characteristics (author-year-country, sample size), study topic, study purpose, sample size, study design, scales used, metabolic variables, sleep quality, and results. Study Characteristics It was determined that the studies included in the systematic review were conducted between 1995 and 2025. When analyzed according to the countries or regions where the studies were conducted, significant variability was observed. Study Topics and Purpose When the topics of studies related to the sleep of individuals with T2DM are examined, it is observed that they cover a wide range. However, the topics have been categorized by the researchers. After this categorization, the topics are as follows: eight studies (%21) focused on sleep quality [ 35 , 44 – 47 , 58 , 62 , 70 ], 11 studies (%28.94) focused on sleep duration [ 34 , 36 – 38 , 40 , 54 , 63 – 67 ], seven studies (%18.42) on sleep disorders [ 39 , 48 , 52 , 55 , 57 , 59 ], three studies (%7.89) on the effect of neuropathic pain on sleep [ 41 – 43 ], and nine studies (%23.68) on sleep apnea in individuals with diabetes [ 49 – 53 , 60 , 61 , 68 , 71 , 72 ]. Sample Size In this systematic review of studies conducted on sleep in diabetic individuals, the studies were analyzed according to their sample sizes. The sample sizes of the studies vary depending on their research designs [ 34 – 72 ]. The smallest sample size included in the studies was 10 [ 68 ], and the largest sample size was 70,026 [ 40 ]. Study Design and Instruments No limitations were applied regarding the study design when including research in the systematic review. Studies were included if they were related to T2DM and sleep. Four of the studies (10.52%) were longitudinal [ 37 , 39 , 57 , 67 ], 10 (26.31%) were cross-sectional [ 35 , 43 , 48 , 50 , 52 , 56 , 57 , 60 , 68 , 70 ], nine (23.68%) were cohort studies (five of which were prospective (13.15%) and four were retrospective (10.52%)) [ 37 – 41 , 49 , 58 , 61 , 71 ], 10 (26.31%) were descriptive [ 42 , 44 – 47 , 51 , 55 , 59 , 62 , 63 ], and five (13.15%) were experimental studies. The scales used for data collection in the included studies varied, as they were selected according to the subject and aim of the study. Metabolic Variables Used in the Studies When examining the relationships between diabetes and sleep in the studies, research focusing on metabolic variables was reviewed. It was found that 10 (26.31%) of the 30 studies included analyzed metabolic variables [ 34 , 35 , 44 , 46 , 48 , 62 – 64 , 71 , 72 ]. The glycemic control variables examined in the studies vary according to the objectives of the research. In five (13.15%) of the studies included, the fasting glucose levels were examined [ 34 , 44 , 46 , 63 , 64 ]. In 10 (26.31%) of the studies, the HbA1c levels were evaluated [ 34 , 35 , 44 , 46 , 48 , 62 – 64 , 71 , 72 ]. In one (2.63%) study, the Glycemic Index was analyzed (48), in two (5.26%) studies, cholesterol levels were examined [ 63 , 64 ], and in one (2.63%) study, kidney function was assessed [ 64 ]. Relationship Level and Outcomes Between T2DM and Sleep Concept The findings and results obtained from the studies included in the systematic review were examined. The results of the studies were categorized according to their objectives. In 12 (31.57%) of the studies, it was found that individuals who sleep for short or long durations have poor metabolic variables [ 34 , 36 – 40 , 47 , 54 , 56 , 66 , 67 , 69 ]. That is, it is stated that there is a significant relationship between the duration of sleep (short or long) and the likelihood of diabetes development. Another nine (23.68%) studies found that the sleep quality of individuals with diabetes was significantly poor [ 35 , 44 – 48 , 57 , 59 , 62 , 63 , 70 , 71 ]. In particular, in six of these nine studies, it was determined that glycemic control variables were an important indicator [ 44 – 49 , 63 , 71 ]. According to the results of three studies included in the research, it was found that diabetic neuropathic pain negatively affects sleep quality [ 41 – 43 ]. In 10 (26.31%) of the studies included in the review, it was observed that obstructive sleep apnea, a sleep disorder, was significantly associated with diabetes [ 49 – 53 , 60 , 61 , 64 , 68 , 72 ]. The results of two (5.26%) studies indicated that nighttime eating habits and poor sleep quality were also affected in individuals with T2DM [ 55 , 65 ]. Only one (2.63%) study reported that the use of oral antidiabetic drugs positively affected sleep quality [ 58 ]. Discussion This systematic review highlights the effects of factors such as sleep duration, quality, sleep disorders, and obstructive sleep apnea (OSA) on the glycemic control and other diabetes-related metabolic parameters in individuals with T2DM. These 38 studies conducted between 1995 and 2025, across different geographical regions, demonstrate an increasing interest in the sleep-diabetes relationship over time, providing significant findings about the depth of this interaction. Limitations found in earlier studies (technological, sample size, methodology, etc.) are less prominent in recent years, with most studies utilizing robust methodological approaches and large sample sizes. This has enhanced the reliability of the results. Additionally, the methodological diversity and differences in sleep measurement techniques have led to some heterogeneity in the findings. This underscores the complexity of the relationship between sleep and diabetes, as well as the importance of individual differences. The sample size in the studies included in this systematic review ranged from 10 to 70,026. The wide range of sample sizes in the studies has increased the diversity of the findings and strengthened their generalizability. In terms of research design, 10.52% of the studies were longitudinal, 26.31% were cross-sectional, 23.68% were cohort studies, 26.31% were descriptive, and 13.15% were experimental. Different scales were selected based on the aim of each study, which enhanced the reliability of the data. In the studies that examined metabolic variables, 10 out of 30 studies (26.31%) addressed metabolic parameters [ 34 , 35 , 44 , 46 , 48 , 62 – 64 , 71 , 72 ]. In these studies, glycemic control variables varied; five studies (13.15%) investigated fasting glucose [ 34 , 44 , 46 , 63 , 64 ], 10 studies (26.31%) examined HbA1c [ 34 , 35 , 44 , 46 , 48 , 62 – 64 , 71 , 72 ], one study (2.63%) assessed the glycemic index [ 48 ], two studies (5.26%) focused on cholesterol [ 63 , 64 ], and one study (2.63%) evaluated kidney function [ 64 ]. The relationship between sleep duration and glycemic parameters is a frequently discussed topic in the literature. Among the 12 studies (31.57%) included in this systematic review, it was found that both very short (less than 6 hours) and very long (more than 9 hours) sleep durations lead to an increase in glucose intolerance, insulin resistance, and HbA1c levels [ 34 – 45 ]. Studies by Yaggi et al. (2006), Punjabi (2004), Gangwisch et al. (2007), and Meslier (2003) emphasize the impact of sleep duration on the metabolic health of individuals with diabetes [ 36 , 37 , 50 , 52 ]. In a study by Jin (2012), a short sleep duration was particularly associated with negative effects on insulin secretion and β-cell function [ 44 ]. These findings suggest a U-shaped relationship between sleep duration and metabolic health. That is, both very short sleep ( 9 hours) were found to be harmful to metabolic health. However, the U-shaped relationship observed in the studies included in this systematic review may vary by gender. For instance, the Ayas et al. (2003) study found that this relationship was only significant in male participants [ 40 ]. These differing findings may help us understand how hormonal differences, lifestyle diversity, and gender-specific metabolic responses shape this relationship. In our study, the effect of sleep quality on glycemic control in individuals with diabetes emerges as one of the most important relationships. In nine studies (23.68%) included in our review, it was observed that the sleep quality of individuals with diabetes was significantly poor [ 34 – 42 ]. In six of these studies (15.79%), poor glycemic control variables were found, with poor sleep quality being associated with increased HbA1c levels and poor glycemic control [ 36 – 39 , 42 , 47 , 48 ]. Factors such as sleep fragmentation, frequent awakenings, and late bedtimes, which negatively affect sleep quality, complicate diabetes management. A study conducted by Trento (2008) highlighted that effective diabetes education not only improved glycemic control but also enhanced sleep quality, which had a positive impact on HbA1c levels [ 48 ]. This indicates that in the effective management of diabetes, not only glycemic parameters but also quality of life should be considered. The diversity of sleep-related factors in individuals with diabetes points to the multifaceted elements affecting sleep quality. Studies focusing on neuropathic pain [ 34 – 36 ] show that such pain negatively affects sleep quality. Additionally, research demonstrating a significant relationship between obstructive sleep apnea and T2DM [ 37 – 39 , 41 ] emphasizes the mutual interaction of these conditions. Links between nocturnal eating habits and poor sleep quality have also been highlighted in some studies [ 42 , 43 ]. Interestingly, only one study [ 44 ] reported the positive effect of oral antidiabetics on sleep quality, suggesting that the potential secondary benefits of pharmacological treatments should be further investigated. Obstructive sleep apnea (OSA) is one of the sleep disorders that most negatively affects glycemic control in individuals with diabetes. Some of the studies included in our systematic review show that OSA leads to increased HbA1c levels, insulin resistance, and the development of T2DM [ 37 , 49 , 51 , 73 ]. In addition to these findings, it has also been reported that more severe forms of OSA have more pronounced negative effects on metabolic health. Two studies reported that CPAP treatment for OSA management did not provide the expected level of improvement in glycemic control [ 73 , 74 ]. This finding suggests that issues with CPAP adherence and the timing of treatment initiation may limit its effects on glycemic control. Effective OSA treatment should not only improve sleep quality but also create broader impacts on diabetes management. To better understand the metabolic effects of OSA, it is necessary to have more detailed knowledge of how intermittent hypoxia and sympathetic activity contribute to disrupting glycemic control. For example, the effects of systemic inflammation and oxidative stress associated with OSA on metabolic health should be key focuses of research in this area. Furthermore, inconsistencies between different diagnostic methods for OSA (e.g., polysomnography, symptom questionnaires) affect the comparability of findings. This highlights the importance of standardizing diagnostic criteria. The impact of sleep patterns and quality on the self-management of diabetes in individuals is also one of the key points examined in this systematic review. Some studies included in the review report that individuals with sleep problems have reduced diabetes coping skills, lower levels of physical activity, and decreased adherence to treatment [ 45 , 47 , 48 ]. Sadosky (2013) noted that complications of diabetes, such as neuropathic pain, negatively affect sleep patterns, leading to more complex effects on metabolic health [ 73 ]. This highlights that diabetes is not only a condition with physiological effects but also one that has psychosocial implications. In this context, treating individuals with diabetes while considering psychosocial factors (such as depression, anxiety, etc.) may result in a more successful treatment process. The effects of sleep duration, quality, and sleep disorders on metabolic health are consistent with the current literature and are supported by biological mechanisms. Spiegel et al. (2004) reported that insufficient sleep disrupts the balance of appetite-regulating hormones such as leptin and ghrelin, leading to insulin resistance [ 21 ]. Tasali et al. (2008) demonstrated that a lack of deep sleep negatively affects the secretion of growth hormone, causing disturbances in glucose metabolism [ 74 ]. Additionally, Punjabi et al. (2009) showed that intermittent hypoxia and increased sympathetic activity associated with OSA trigger systemic inflammation, impairing glycemic control [ 75 ]. These findings emphasize that sleep patterns have a multifaceted impact on diabetes management, and managing sleep problems in individuals with diabetes is crucial for metabolic health. Our systematic review shows that the deterioration of sleep quality in individuals with T2DM negatively affects diabetes management and overall health. In a systematic review conducted by Abate et al. (2024), poor sleep quality was found to be prevalent in 48.54% of individuals with diabetes in Ethiopia. This prevalence rate is similar to the findings of studies included in our review, conducted in various countries. In our systematic review, nine studies (23.68%) found that sleep quality was significantly poor in individuals with T2DM, and particularly in 6 of these studies, significant associations were found between poor sleep quality and glycemic control variables. However, while Abate et al. (2024) focused solely on the prevalence of poor sleep quality, our study examined a broader range of sleep-related issues, including sleep quality, duration, disorders, and apneas, and assessed the relationships with metabolic variables [ 76 ]. Limitations The lack of standardization in the methods used to assess sleep quality in the studies included in our research (such as PSQI, subjective evaluation surveys, etc.) has limited the comparability of the findings. Moving forward, measuring sleep quality using more objective and reliable methods will allow for more robust results in future studies. In particular, further research on the relationship between sleep disorders (such as insomnia and parasomnias) and diabetes will be essential for gaining a deeper understanding of this connection. Furthermore, data inconsistencies may arise due to cultural, socioeconomic, and healthcare system differences. While this diversity ensures a broad scope of findings, the impact of methodological and regional factors should be carefully considered. Additionally, variations in sample size can create methodological inconsistencies. Therefore, it is crucial for future research to use more homogeneous sample groups to make the results more consistent. Conclusions The treatment of sleep disorders is crucial for improving diabetes management, and further research is needed in this area. Combining psychological treatments, sleep therapies, and lifestyle changes may enhance the positive effects on metabolic health. In this context, future studies should focus on the detailed examination of the relationships between sleep disorder management and diabetes treatment. Improving sleep quality can potentially make diabetes management more effective. As a result, the relationship between sleep quality, sleep duration, and diabetes can both trigger metabolic disorders and contribute to the worsening of existing diabetes. This highlights the importance of not overlooking sleep disorders in diabetes treatment and suggests that improving sleep patterns could be a vital strategy for achieving better glycemic control in patients. Future research should explore the interactions between sleep, diabetes, and psychosocial factors more thoroughly, paving the way for the development of more effective treatment approaches. Declarations Human and Animal Rights and Informed Consent This article does not contain any studies with human or animal subjects performed by any of the authors. Funding None Daya Availability No datasets were generated or analysed during the current study. Competing Interests The authors declare no competing interests. Author Contributions: Study Design: D.T. Search assessment of the articles: D.T., E.K. Interpretation of the results, drafted sections: D.T., E.K., E.B. Revision of the manuscript: E.K. All authors approved the final copy of the manuscript. References Türkiye Cumhuriyeti Sağlık Bakanlığı (2011) Türkiye Diyabet Önleme ve Kontrol Programı 2011–2020 . Sağlık Bakanlığı Yayınları Satman I, Yılmaz T, Tutuncu Y (2002) Population-based study of diabetes and risk characteristics in Turkey: Results of the Turkish Diabetes Epidemiology Study (TURDEP). Diabetes Care 25(9):1551–1556. https://doi.org/10.2337/diacare.25.9.1551 Turkish Endocrinology and Metabolism Society (2014) Clinical guidelines for endocrine disorders. Turkish Endocrinology and Metabolism Society Knutson KL, Spiegel K, Penev P, Van Cauter E (2007) The metabolic consequences of sleep deprivation. Sleep Med Rev 11(3):163–178. https://doi.org/10.1016/j.smrv.2007.01.002 Lim LL, Foldvary-Schaefer N (2010) Sleep disorders. In: Tavee J (ed) Current clinical medicine. Elsevier Health Sciences, pp 914–915 Hernandez A, Philippe J, Jornayvaz FR (2012) Sleep and diabetes. Revue Médicale Suisse 8(344):1198–1200 Kline CE, Irish LA, Krafty RT, Sternfeld B, SWAN Study Group (2013) Consistently high sports/exercise activity is associated with better sleep quality, continuity, and depth in midlife women: The SWAN Sleep Study. Sleep 36(9):1279–1288. https://doi.org/10.5665/sleep.2928 Buysse DJ, Reynolds CF, Monk TH, Berman SS, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res 28(2):193–213. https://doi.org/10.1016/0165-1781(89)90047-4 Van Cauter E, Knutson K, Leproult R, Spiegel K (2005) The impact of sleep deprivation on hormones and metabolism. Medscape Neurol, 7 (1). https://www.medscape.com/viewarticle/500632 Bonnet MH, Arand DL (1995) We are chronically sleep deprived. Sleep 18(9):908–911 American Academy of Sleep Medicine (AASM) (2007) International classification of sleep disorders, 2nd edn. American Academy of Sleep Medicine National Center for Health Statistics (2005) National Health Interview Survey, 2005 . Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/nhis.htm Demir A (2010) Türkiye'de erişkin toplumda uyku epidemiyolojisi çalışması ilk sonuçları 2010. Türkiye: Türk Tıbbi Uyku Derneği Yayını; 2010 Van Cauter E, Polonsky KS, Scheen AJ (1997) Roles of circadian rhythmicity and sleep in human glucose regulation. Endocr Rev 18(5):716–738. https://doi.org/10.1210/edrv.18.5.0317 Van Cauter E, Blackman JD, Roland D, Spire JP (1991) & colleagues. Modulation of glucose regulation and insulin secretion by circadian rhythmicity and sleep. The Journal of Clinical Investigation, 88 (3), 934–942. https://doi.org/10.1172/JCI115070 Van Cauter E, Spiegel K, Tasali E, Leproult R (2008) Metabolic consequences of sleep and sleep loss. Sleep Med 9(Suppl 1):S23–S28. https://doi.org/10.1016/j.sleep.2008.01.001 Van Cauter E, Holmback U, Knutson K, Leproult R (2007) & colleagues. Impact of sleep and sleep loss on neuroendocrine and metabolic function. Hormone Research, 67 (Suppl 1), 2–9. https://doi.org/10.1159/000096711 Spiegel K, Leproult R, Van Cauter E (1999) Impact of sleep debt on metabolic and endocrine function. Lancet 354(9188):1435–1439. https://doi.org/10.1016/S0140-6736(99)01376-8 Yildiz BO, Suchard MA, Wong M-L, McCann SM, Licinio J (2004) Alterations in the dynamics of circulating ghrelin, adiponectin, and leptin in human obesity. Proc Natl Acad Sci USA 101(28):10434–10439. https://doi.org/10.1073/pnas.0403465101 Stamatakis KA, Punjabi NM (2010) Effects of sleep fragmentation on glucose metabolism in normal subjects. Chest 137(1):95–101. https://doi.org/10.1378/chest.09-1457 Spiegel K, Leproult R, L’Hermite-Balériaux M, Copinschi G (2004) & colleagues. Leptin levels are dependent on sleep duration: Relationships with sympathovagal balance, carbohydrate regulation, cortisol, and thyrotropin. The Journal of Clinical Endocrinology & Metabolism, 89 (11), 5762–5771. https://doi.org/10.1210/jc.2004-0364 Vgontzas AN, Mastorakos G, Bixler EO, Kales A (1999) & colleagues. Sleep deprivation effects on the activity of the hypothalamic-pituitary-adrenal and growth axes: Potential clinical implications. Clinical Endocrinology, 51 (2), 205–215. https://doi.org/10.1046/j.1365-2265.1999.00951.x Irwin M, Thompson J, Miller C, Gillin JC (1999) & colleagues. Effects of sleep and sleep deprivation on catecholamine and interleukin-2 levels in humans: Clinical implications. The Journal of Clinical Endocrinology & Metabolism, 84 (6), 1979–1985. https://doi.org/10.1210/jcem.84.6.5776 Somers VK, Dyken ME, Clary MP, Abboud FM (1995) Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Investig 96(4):1897–1904. https://doi.org/10.1172/JCI118942 Kessler L, Nedeltcheva A, Imperial J, Penev PD (2010) Changes in serum TSH and free T4 during human sleep restriction. Sleep 33(8):1115–1118. https://doi.org/10.1093/sleep/33.8.1115 Lucassen EA, Rother KI, Cizza G (2012) Interacting epidemics? Sleep curtailment, insulin resistance, and obesity. Ann N Y Acad Sci 1264(1):110–134. https://doi.org/10.1111/j.1749-6632.2012.06655.x Taub LF, Redeker NS (2008) Sleep disorders, glucose regulation, and T2DM. Biol Res Nurs 9(3):231–243. https://doi.org/10.1177/1099800408320656 Knutson KL, Van Cauter E (2008) Associations between sleep loss and increased risk of obesity and diabetes. Ann N Y Acad Sci 1129:287–304. https://doi.org/10.1196/annals.1417.033 American Diabetes Association (2014) Standards of medical care in diabetes—2014. Diabetes Care 37(Suppl 1):S14–S80. https://doi.org/10.2337/dc14-S014 Turkish Endocrinology and Metabolism Society (2014) Diabetes mellitus tanı ve tedavi rehberi [Diabetes mellitus diagnosis and treatment guide]. TEMD International Diabetes Federation (2014) IDF diabetes atlas, 6th edn. International Diabetes Federation Kalav S, Altın-Çetin A, Bektaş H (2020) The effect of oral hygiene practices in stroke patients: A systematic review. Turkiye Klinikleri J Nurs Sci 12(3):430–442. https://doi.org/10.5336/nurses.2020-74729 Bağriaçik E, Bayraktar N (2022) Effectiveness of training in disease management for patients with T2DM mellitus: A systematic review. Endocrinología, Diabetes y Nutrición (English ed. 69(5):362–378. https://doi.org/10.1016/j.endien.2022.02.001 Nakajima, H.,Kaneita, Y., Yokoyama, E., Harano, S., Tamaki, T., Ibuka, E., … & Ohida, T. (2008). Association between sleep duration and hemoglobin A1c level. Sleep Medicine,9(7), 745–752. https://doi.org/10.1016/j.sleep.2007.10.004 Cunha MCBD, Zanetti ML, Hass VJ (2008) Sleep quality in type 2 diabetics. Revista Latino- Americana de Enfermagem 16(5):850–855. https://doi.org/10.1590/S0104-11692008000500012 Gangwisch, J. E., Heymsfield, S. B., Boden-Albala, B., Buijs, R. M., Kreier, F., Pickering,T. G., … Malaspina,D. (2007). Sleep duration as a risk factor for diabetes incidence in a large US sample. Sleep, 30(12), 1667–1673. https://doi.org/10.1093/sleep/30.12.1667 Yaggi HK, Araujo AB, McKinlay JB (2006) Sleep duration as a risk factor for the development of T2DM. Diabetes Care 29(3):657–661. https://doi.org/10.2337/dc05-0981 Gottlieb DJ, Punjabi NM, Newman AB, Resnick HE, Redline S, Baldwin CM, Nieto FJ (2005) Association of sleep time with diabetes mellitus and impaired glucose tolerance. Arch Intern Med 165(8):863–867. https://doi.org/10.1001/archinte.165.8.863 Meisinger C, Heier M, Loewel H (2005) Sleep disturbance as a predictor of T2DM mellitus in men and women from the general population: Results from the MONICA/KORA Augsburg Cohort Study. Diabetologia 48(2):235–241. https://doi.org/10.1007/s00125-004-1644-7 Ayas, N.T., White, D. P., Al-Delaimy, W. K., Manson, J. E., Stampfer, M. J., Speizer, F. E., … & Hu, F. B. (2003). A prospective study of self-reported sleep duration and incident diabetes in women. Diabetes Care, 26(2),380–384. https://doi.org/10.2337/diacare.26.2.380 Sadosky A, Hopper J, Parsons B (2014) Painful diabetic peripheral neuropathy: Results of a survey characterizing the perspectives and misperceptions of patients and healthcare practitioners. Patient - Patient-Centered Outcomes Res 7(2):107–114. https://doi.org/10.1007/s40271-014-0045-4 Zelman DC, Brandenburg NA, Gore M (2006) Sleep impairment in patients with painful diabetic peripheral neuropathy. Clin J Pain 22(8):681–685. https://doi.org/10.1097/01.ajp.0000239723.13221.2b Gore M, Brandenburg NA, Dukes E, Hoffman DL, Tai K-S, Stacey B (2005) Pain severity in diabetic peripheral neuropathy is associated with patient functioning, symptom levels of anxiety and depression, and sleep. J Pain Symptom Manag 30(4):374–385. https://doi.org/10.1016/j.jpainsymman.2005.04.009 Jin QH, Chen HH, Yu HL, Li TL (2012) The relationship between sleep quality and glucose level, diabetic complications in elderly T2DM mellitus. Zhonghua nei ke za zhi 51(5):357–361 PMID: 22883333 Tsai Y-W, Kann N-H, Tung T-H, Chao Y-J, Lin C-J, Chang K-C, Chang S-S, Chen J-Y (2012) Associations of health literacy and sleep problems with chronic disease in Taiwanese adults. Fam Pract 29(1):30–35. https://doi.org/10.1093/fampra/cmr041 Nakanishi-Minami T, Kishida K, Funahashi T, Shimomura I (2012) Sleep-wake cycle irregularities in type 2 diabetics. Diabetol Metab Syndr., 4, Article 18 https://doi.org/10.1186/1758-5996-4-18 Luyster FS, Dunbar-Jacob J (2011) Sleep quality and quality of life in adults with T2DM. Diabetes Educ 37(3):347–355. https://doi.org/10.1177/0145721711406137 Trento, M., Broglio, F., Riganti, F., Basile, M., Borgo, E., Kucich, C.,… Porta, M. (2008). Sleep abnormalities in T2DM may be associated with glycemic control. Acta Diabetologica, 45(3), 225–229. https://doi.org/10.1007/s00592-007-0073-5 Kosseifi S, Bailey B, Price R, Roy TM, Byrd RP Jr., Peiris AN (2010) The association between obstructive sleep apnea syndrome and microvascular complications in well-controlled diabetic patients. Mil Med 175(11):913–916. https://doi.org/10.7205/MILMED-D-09-00355 Meslier N, Gagnadoux F, Giraud P, Person C, Ouksel H, Urban T, Racineux JL (2003) Impaired glucose-insulin metabolism in males with obstructive sleep apnoea syndrome. Eur Respir J 22(1):156–160. https://doi.org/10.1183/09031936.03.00048502 Elmasry A, Lindberg E, Berne C, Janson C, Gislason T, Awad TM, Boman G (2001) Sleep- disordered breathing and glucose metabolism in hypertensive men: A population-based study. J Intern Med 249(2):153–161. https://doi.org/10.1046/j.1365-2796.2001.00894.x Punjabi NM, Shahar E, Redline S, Gottlieb DJ, Givelber R, Resnick HE (2004) Sleep- disordered breathing, glucose intolerance, and insulin resistance: The Sleep Heart Health Study. Am J Epidemiol 160(6):521–530. https://doi.org/10.1093/aje/kwh261 Somers VK, Dyken ME, Clary MP, Abboud FM (1995) Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Investig 96(4):1897–1904. https://doi.org/10.1172/JCI118235 Ohkuma, T., Fujii, H., Iwase, M., Ogata-Kaizu, S., Ide, H., Kikuchi, Y., …Kitazono, T. (2014). U-shaped association of sleep duration with metabolic syndrome and insulin resistance in patients with T2DM: The Fukuoka Diabetes Registry. Metabolism, 63(4), 484–491. https://doi.org/10.1016/j.metabol.2013.12.006 Hood MM, Reutrakul S, Crowley SJ (2014) Night eating in patients with T2DM: Associations with glycemic control, eating patterns, sleep, and mood. Appetite 79:91–96. https://doi.org/10.1016/j.appet.2014.04.005 Tare,A., Lane, J. M., Cade, B. E., Grant, S. F., Chen, T. H., Punjabi, N. M., … & Saxena, R. (2014). Sleep duration does not mediate or modify association of common genetic variants with T2DM. Diabetologia, 57, 339–346. https://doi.org/10.1007/s00125-013-3098-7 Tanno,S., Tanigawa, T., Saito, I., Nishida, W., Maruyama, K., Eguchi, E., … Punjabi, N. M. (2014). Sleep- related intermittent hypoxemia and glucose intolerance: A community-based study.Sleep Medicine, 15(10), 1212–1218. https://doi.org/10.1016/j.sleep.2014.05.019 Kajbaf F, Fendri S, Basille-Fantinato A, Diouf M, Rose D, Jounieaux V, Lalau J-D (2014) The relationship between metformin therapy and sleep quantity and quality in patients with T2DM referred for potential sleep disorders. Diabet Med 31(5):577–580. https://doi.org/10.1111/dme.12362:contentReference[oaicite:7]{index=7} Costa EG, Campos RP, Costa EC (2014) Relationship between socio demographic, clinical and psychosocial variables in patients with T2DM. Análise Psicológica 32(1):63–77. https://doi.org/10.14417/ap.734 Obaseki DO, Kolawole BA, Gomerep SS, Obaseki JE, Abidoye IA, Ikem RT, Erhabor GE (2014) Prevalence and predictors of obstructive sleep apnea syndrome in a sample of patients with T2DM mellitus in Nigeria. Nigerian Med J 55(1):24–28. https://doi.org/10.4103/0300- 1652.126291 Lai Y-J, Lin C-L, Lin M-C, Lee S-T, Sung F-C, Chang Y-J, Kao C-H (2013) Population-based cohort study on the increase in the risk for T2DM mellitus development from nonapnea sleep disorders. Sleep Med 14(9):913–918. https://doi.org/10.1016/j.sleep.2013.03.024 Song Y, Ye X, Ye L, Li B, Wang L, Hua Y (2013) Disturbed subjective sleep in Chinese females with T2DM on insulin therapy. PLoS ONE 8(1):e54951. https://doi.org/10.1371/journal.pone.0054951 St-Onge M-P, Zammit G, Reboussin DM, Kuna ST, Sanders MH, Millman R, Newman AB, Wadden TA, Wing RR, Pi-Sunyer FX, Foster GD, Sleep AHEAD Research Group (2012) Associations of sleep disturbance and duration with metabolic risk factors in obese persons with T2DM: Data from the Sleep AHEAD Study. Nat Sci Sleep 4:143–150. https://doi.org/10.2147/NSS.S35797 Buyukaydin B, Akkoyunlu ME, Kazancioglu R, Karakose F, Ozcelik HK, Erkoc R, Kart L (2012) The effect of sleep apnea syndrome on the development of diabetic nephropathy in patients with T2DM. Diabetes Res Clin Pract 98(1):140–143. https://doi.org/10.1016/j.diabres.2012.08.011 Cros, J., Pianezzi,E., Rosset, R., Egli, L., Schneiter, P., Cornette, F., … Lecoultre, V. (2019). Impact of sleep restriction on metabolic outcomes induced by overfeeding: A randomized controlled trial in healthy individuals. The American Journal of Clinical Nutrition, 109(1), 17–28. https://doi.org/10.1093/ajcn/nqy255 Radcliffe PN, Whitney CC, Fagnant HS, Wilson MA, Finlayson G, Smith TJ, Karl JP (2021) Severe sleep restriction suppresses appetite independent of effects on appetite regulating hormones in healthy young men without obesity. Physiol Behav 237:113438. https://doi.org/10.1016/j.physbeh.2021.113438 Tajiri E, Yoshimura E, Hatamoto Y, Tanaka H, Shimoda S (2018) Effect of sleep curtailment on dietary behavior and physical activity: A randomized crossover trial. Physiol Behav 184:60–67. https://doi.org/10.1016/j.physbeh.2017.11.002 Abdissa D (2020) Prevalence of obstructive sleep apnea risk and associated factors among patients with T2DM mellitus on follow-up at Jimma Medical Center, Southwest Ethiopia. J Clin Translational Endocrinol 21:100234. https://doi.org/10.1016/j.jcte.2020.100234 Wang X, Greer J, Porter R, Kaur K, Youngstedt S, Fayad R (2015) Short-term moderate sleep restriction increases insulin concentration following oral glucose tolerance test. FASEB J 29(2):805–809. https://doi.org/10.1096/fj.14-263947 Zhang J, Yang C, An J, Fan Y, Dong X, Brain (2025) Behav Immun - Health, 100953. https://doi.org/10.1016/j.bbih.2024.100953 Grimaldi D, Beccuti G, Touma C, Van Cauter E, Mokhlesi B (2014) Association of obstructive sleep apnea in rapid eye movement sleep with reduced glycemic control in T2DM: Therapeutic implications. Diabetes Care 37(2):355–363. https://doi.org/10.2337/dc13-109672 West SD, Nicoll DJ, Wallace TM, Matthews DR, Stradling JR (2007) Effect of CPAP on insulin resistance and HbA1c in men with obstructive sleep apnoea and T2DM. Thorax 62(11):969–974. https://doi.org/10.1136/thx.2006.06643873 Sadosky A, Schaefer C, Mann R, Bergstrom F, Baik R, Parsons B, Nalamachu S, Nieshoff E, Stacey BR, Anschel A, Tuchman M (2013) Burden of illness associated with painful diabetic peripheral neuropathy among adults seeking treatment in the US: Results from a retrospective chart review and cross-sectional survey. Diabetes Metabolic Syndrome Obesity: Targets Therapy 6:79–92. https://doi.org/10.2147/DMSO.S37415 Tasali E, Leproult R, Ehrmann DA, Van Cauter E (2008) Slow-wave sleep and the risk of T2DM in humans. Proceedings of the National Academy of Sciences, 105 (3), 1044–1049. https://doi.org/10.1073/pnas.0706446105 Punjabi NM, Beamer BA, Zhang Y (2009) Effects of acute intermittent hypoxia on glucose metabolism in awake healthy volunteers. J Appl Physiol 106(5):1538–1544. https://doi.org/10.1152/japplphysiol.91523.2008 Abate HK, Azagew AW, Nega GA, Birru SM, Mekonnen CK (2024) Prevalence and determinants of poor sleep quality among diabetic patients in Ethiopia: Systematic review. Front Public Health 12:1363408. https://doi.org/10.3389/fpubh.2024.1363408 Tables Table 1 is available in the Supplementary Files section. Additional Declarations The authors declare no competing interests. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6820219","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":466424606,"identity":"ba19155d-9e13-43c8-946c-200c29c6a990","order_by":0,"name":"Deniz TALAZ","email":"","orcid":"https://orcid.org/0009-0005-8292-6521","institution":"Near East University Faculty of Nursing","correspondingAuthor":false,"prefix":"","firstName":"Deniz","middleName":"","lastName":"TALAZ","suffix":""},{"id":466424607,"identity":"9f5aa367-784a-462f-b6d6-8ae8b0274965","order_by":1,"name":"Elem KOCAÇAL","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwElEQVRIiWNgGAWjYBACCQhlIQciDzwgQYuEMVhLAilaEhtAFFFaJNubH374USORPj/s8EOgLXZyug0EtEjzHDOW7DkmkbvxdpoBUEuysdkBAlrkJHIYpBnYgFpmJ4C0HEjcRoQW5t8M/yTSDWenfyBOi7REDps0Y5tEgrx0DpG2AP1hZtnbJ2G4QTqn4ECCARF+kTje/PjGj2828vKz0zd/+FBhJ0dQCxwYgFUaEKscBOQbSFE9CkbBKBgFIwoAALtZQQwuU1inAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0001-8771-5786","institution":"İzmir Demokrasi University Faculty of Health Sciences","correspondingAuthor":true,"prefix":"","firstName":"Elem","middleName":"","lastName":"KOCAÇAL","suffix":""},{"id":466424608,"identity":"730e4c87-d119-41ea-ba02-6c5d657bc545","order_by":2,"name":"Ezgi BAĞRIAÇIK","email":"","orcid":"https://orcid.org/0000-0001-9061-1769","institution":"Near East University Faculty of Nursing","correspondingAuthor":false,"prefix":"","firstName":"Ezgi","middleName":"","lastName":"BAĞRIAÇIK","suffix":""}],"badges":[],"createdAt":"2025-06-04 11:53:39","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6820219/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6820219/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83958642,"identity":"abaa06b3-965c-406e-917c-58d8dd245028","added_by":"auto","created_at":"2025-06-05 04:08:56","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":55176,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eThe Relationship Between Ineffective Sleep and Glycemic Control (Sleep Disorders and Changes in Neurohormonal Functioning [26,27]\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e","description":"","filename":"11.png","url":"https://assets-eu.researchsquare.com/files/rs-6820219/v1/10938339f123fa99882dff30.png"},{"id":83958762,"identity":"6d140f96-98ca-4dd3-88ff-94761115bfb0","added_by":"auto","created_at":"2025-06-05 04:16:54","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":36568,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFIGURE 1 \u003c/strong\u003ePRISMA Flowchart\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6820219/v1/a31b1a578b95224a551efe24.png"},{"id":83959122,"identity":"93b19232-12a3-4a02-bc22-58d8560b8ad1","added_by":"auto","created_at":"2025-06-05 04:24:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":803560,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6820219/v1/23bbf308-e371-42ad-ba40-b7add8452167.pdf"},{"id":83958614,"identity":"1ab4b308-526e-4e5a-a76f-1a92c35760e9","added_by":"auto","created_at":"2025-06-05 04:08:54","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":75744,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6820219/v1/c969219215a530a1184f9d13.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eA Systematic Review of Studies Investigating the Impact of Sleep Quality on Metabolic Variables in Individuals With T2DM\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe prevalence of diabetes is steadily increasing both globally and in Turkey, with the incidence of type 2 diabetes (T2DM) rising rapidly, particularly in developed and developing countries [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In the adult population of Turkey, the prevalence of diabetes was reported as 7.2% in the Turkish Diabetes, Hypertension, Obesity and Endocrinological Diseases Prevalence Study-I (TURDEP-I) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], whereas this rate increased to 13.7% in the TURDEP-II study [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Factors contributing to the increase in diabetes include longer life expectancy, lifestyle changes due to urbanization, physical inactivity, and dietary habits [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Moreover, inadequate sleep has also been identified as a risk factor for diabetes. A clinical review noted that the decline in average sleep duration in the United States of America (USA) coincided with the increased prevalence of diabetes and obesity [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSleep is defined as an active physiological state involving sustained unresponsiveness to the external environment and dynamic changes in neurological, metabolic, and cardiorespiratory functions [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Although it varies by individual and age, the ideal sleep duration for adults is on average 7\u0026ndash;8 hours [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Quality sleep is recommended to be timely, of sufficient duration, and uninterrupted [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, due to current living conditions or physiological and psychological problems, sleep disorders have become a widespread concern [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Sleep disorders are characterized by disruptions in sleep patterns and refer to issues related to the quality, timing, and quantity of sleep. They include difficulties in falling asleep and maintaining sleep, falling asleep at inappropriate times, sleeping too much or too little, and exhibiting abnormal behaviors during sleep [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Over the past 50 years, daily sleep duration has decreased by 1.5 to 2 hours among adults and adolescents, and approximately one-third of Americans aged 30\u0026ndash;64 are reported to sleep less than six hours a day [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Similar results have drawn attention in Turkey. According to the \u0026ldquo;National Sleep Epidemiology Study in the Adult Population,\u0026rdquo; which mapped Turkey\u0026rsquo;s sleep profile, 13% of people reported having difficulty falling asleep, 30% slept more than eight hours, and 11% slept less than six hours [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDuring sleep, changes occur in hormone levels that regulate body metabolism. Blood glucose levels and insulin concentrations are higher during nighttime sleep compared to daytime and nighttime wakefulness [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Glucose utilization is highest during wakefulness, lowest during Non-Rapid Eye Movement (NREM) sleep, and moderate during Rapid Eye Movement (REM) sleep; glucose tolerance is also lower throughout the night [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Growth hormone rises at the onset of sleep and reaches its peak level during slow-wave sleep (SWS). Cortisol levels significantly increase in the second half of sleep, predominantly during REM sleep [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Thyroid-stimulating hormone (TSH) secretion increases during nighttime sleep [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Leptin follows a circadian rhythm that peaks in the early phases of the sleep period [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], while circulating ghrelin concentrations also exhibit a peak at their maximum level during the night [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn sleep disorders, changes in neurohormonal functioning\u0026mdash;such as increased sympathetic activity [\u003cspan additionalcitationids=\"CR21 CR22 CR23\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] and elevated cortisol levels [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], suppression of growth hormone [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] and TSH secretion [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], and reduced leptin secretion [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u0026mdash;lead to obesity, hyperglycemia, and insulin resistance [\u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). As a result, diabetes, its micro- and macrovascular complications, hypoglycemia, neuropathic pain, diabetic foot ulcers, sleep apnea, and depression may also develop, further impairing sleep effectiveness and quality. Consequently, sleep influences the development of diabetes and its complications, while diabetes also impacts sleep [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough sleep has been shown to be an important factor in blood glucose regulation, current guidelines for the follow-up and care of individuals with diabetes [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] do not include a focus on sleep. Therefore, the aim of this article is to highlight the relationship between diabetes\u0026mdash;a chronic disease that is highly prevalent both globally and in our country, and requires continuous monitoring and care\u0026mdash;and sleep, and to raise awareness of the importance of effective sleep in individuals with diabetes. This article will review topics such as glucose metabolism in the context of sleep and sleep disorders, the effects of diabetes on sleep, sleep from a nursing perspective, and will discuss the importance of evaluating the sleep patterns of diabetic patients.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eAim\u003c/strong\u003e \u003cp\u003eThis systematic review aims to evaluate studies investigating the effects of sleep and sleep disorders related to the disease on glucose metabolism in individuals with T2DM.\u003c/p\u003e \u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis systematic review was prepared according to the recommendations of the \u0026quot;Preferred Reporting Items for Systematic Review and Meta Analysis Protocols 2015 Statement (PRISMA-P).\u0026quot; Since the review was conducted by examining existing studies, ethical committee approval was not required for the study [\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eThis systematic review was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD420251042052. The registered protocol, titled \u0026quot;Evaluation of Studies Examining the Effect of Sleep Quality on Metabolic Variables in Individuals with T2DM: A Systematic Review\u0026quot;, outlines the objectives, eligibility criteria, and planned methodology for study selection, data extraction, and synthesis.\u003c/p\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eSearch Strategy\u003c/h2\u003e\n \u003cp\u003eFor this systematic review, a search was conducted using the English keywords \u0026quot;sleep and diabetes, diabetes and sleep disorders, sleep in T2DM, sleep quality and Diabetes Mellitus, the importance of sleep in diabetes, the effect of sleep on diabetes and diabetes on sleep\u0026quot; without any year restrictions, from January 3, 2023, to March 25, 2025. The databases used for the search include Google Scholar, Medline/PubMed, Cochrane Library, Science Direct, CINAHL Complete, OVID, and Web of Science. The number of studies found was categorized by database and shown in the PRISMA flow diagram (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eInclusion Criteria\u003c/h3\u003e\n\u003cp\u003eThe systematic review included studies that investigate the effects of sleep and sleep disorders related to the disease on glucose metabolism in individuals with T2DM. Only studies written in English, with full-text availability, and published in a review design were included.\u003c/p\u003e\n\u003cp\u003eThe studies included in the systematic review were selected based on the \u0026lsquo;P: Population (type of participants), participant characteristics; I: Intervention (types of interventions), intervention characteristics; C: Comparator (types of comparisons), comparison groups; O: Outcome (types of outcomes), outcomes; S: Study designs (types of studies), study design (PICOS) model recommended by the Joanna Briggs Institute [\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eP:\u0026nbsp;\u003c/strong\u003eStudies examining the effect of disease-related sleep and sleep disorders on glucose metabolism in individuals with T2DM, regardless of gender, race, and socio-economic status, were included in the review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eI:\u0026nbsp;\u003c/strong\u003eStudies investigating the effects of disease-related sleep and sleep disorders on glucose metabolism in individuals with T2DM were reviewed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eC:\u0026nbsp;\u003c/strong\u003eStudies discussing the effects of disease-related sleep and sleep disorders on glucose metabolism in individuals with T2DM, as well as the effectiveness of other interventions, were included.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eO:\u0026nbsp;\u003c/strong\u003eParameters affecting glucose metabolism in individuals with T2DM due to sleep and sleep disorders were assessed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eS:\u0026nbsp;\u003c/strong\u003eThe studies included were randomized controlled trials, descriptive studies, and relational design research.\u003c/p\u003e\n\u003ch3\u003eExclusion Criteria\u003c/h3\u003e\n\u003cp\u003eStudies reporting no results on the effect of disease-related sleep and sleep disorders on glucose metabolism in individuals with T2DM, as well as those outside the scope of randomized controlled trials, descriptive, and relational designs, were not included in this study.\u003c/p\u003e\n\u003ch3\u003eStudy selection\u003c/h3\u003e\n\u003cp\u003eStudies were independently selected by the researchers. A total of 1452 studies from Google Scholar (n\u0026thinsp;=\u0026thinsp;754), Medline/PubMed (n\u0026thinsp;=\u0026thinsp;126), Cochrane Library (n\u0026thinsp;=\u0026thinsp;587), Science Direct (n\u0026thinsp;=\u0026thinsp;60), CINAHL Complete (n\u0026thinsp;=\u0026thinsp;203), OVID (n\u0026thinsp;=\u0026thinsp;115) and Web of Science (n\u0026thinsp;=\u0026thinsp;107) were accessed as a result of an electronic search with keywords. From these articles, 38 studies were included in the systematic review after excluding those that they did not meet the inclusion criteria, had inappropriate titles and abstracts, were duplicated, or had inappropriate content (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAs a result of searching the identified keywords and their synonyms, a total of 1452 studies were found from Google Scholar (754), PubMed/Medline (126), CINAHL Complete (203), Science Direct (60), Web of Science (107), Cochrane Library (87), and Ovid (115). After removing duplicate studies, studies with inappropriate titles and abstracts were excluded. The remaining 546 studies were re-evaluated according to inclusion and exclusion criteria. Based on this evaluation, 38 studies meeting the inclusion criteria were included in the study (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe findings obtained from the detailed analysis of the 38 studies included in the systematic review (as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) were evaluated under 9 headings: research characteristics (author-year-country, sample size), study topic, study purpose, sample size, study design, scales used, metabolic variables, sleep quality, and results.\u003c/p\u003e\n\u003ch3\u003eStudy Characteristics\u003c/h3\u003e\n\u003cp\u003eIt was determined that the studies included in the systematic review were conducted between 1995 and 2025. When analyzed according to the countries or regions where the studies were conducted, significant variability was observed.\u003c/p\u003e\n\u003ch3\u003eStudy Topics and Purpose\u003c/h3\u003e\n\u003cp\u003eWhen the topics of studies related to the sleep of individuals with T2DM are examined, it is observed that they cover a wide range. However, the topics have been categorized by the researchers. After this categorization, the topics are as follows: eight studies (%21) focused on sleep quality [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan additionalcitationids=\"CR45 CR46\" citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e], 11 studies (%28.94) focused on sleep duration [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan additionalcitationids=\"CR37\" citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan additionalcitationids=\"CR64 CR65 CR66\" citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e], seven studies (%18.42) on sleep disorders [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e], three studies (%7.89) on the effect of neuropathic pain on sleep [\u003cspan additionalcitationids=\"CR42\" citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e], and nine studies (%23.68) on sleep apnea in individuals with diabetes [\u003cspan additionalcitationids=\"CR50 CR51 CR52\" citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSample Size\u003c/h2\u003e \u003cp\u003eIn this systematic review of studies conducted on sleep in diabetic individuals, the studies were analyzed according to their sample sizes. The sample sizes of the studies vary depending on their research designs [\u003cspan additionalcitationids=\"CR35 CR36 CR37 CR38 CR39 CR40 CR41 CR42 CR43 CR44 CR45 CR46 CR47 CR48 CR49 CR50 CR51 CR52 CR53 CR54 CR55 CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69 CR70 CR71\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e]. The smallest sample size included in the studies was 10 [\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e], and the largest sample size was 70,026 [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Instruments\u003c/h2\u003e \u003cp\u003eNo limitations were applied regarding the study design when including research in the systematic review. Studies were included if they were related to T2DM and sleep. Four of the studies (10.52%) were longitudinal [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e], 10 (26.31%) were cross-sectional [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e], nine (23.68%) were cohort studies (five of which were prospective (13.15%) and four were retrospective (10.52%)) [\u003cspan additionalcitationids=\"CR38 CR39 CR40\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e], 10 (26.31%) were descriptive [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan additionalcitationids=\"CR45 CR46\" citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e], and five (13.15%) were experimental studies. The scales used for data collection in the included studies varied, as they were selected according to the subject and aim of the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eMetabolic Variables Used in the Studies\u003c/h2\u003e \u003cp\u003eWhen examining the relationships between diabetes and sleep in the studies, research focusing on metabolic variables was reviewed. It was found that 10 (26.31%) of the 30 studies included analyzed metabolic variables [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan additionalcitationids=\"CR63\" citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e]. The glycemic control variables examined in the studies vary according to the objectives of the research. In five (13.15%) of the studies included, the fasting glucose levels were examined [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e]. In 10 (26.31%) of the studies, the HbA1c levels were evaluated [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan additionalcitationids=\"CR63\" citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e]. In one (2.63%) study, the Glycemic Index was analyzed (48), in two (5.26%) studies, cholesterol levels were examined [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e], and in one (2.63%) study, kidney function was assessed [\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eRelationship Level and Outcomes Between T2DM and Sleep Concept\u003c/h2\u003e \u003cp\u003eThe findings and results obtained from the studies included in the systematic review were examined. The results of the studies were categorized according to their objectives. In 12 (31.57%) of the studies, it was found that individuals who sleep for short or long durations have poor metabolic variables [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan additionalcitationids=\"CR37 CR38 CR39\" citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e]. That is, it is stated that there is a significant relationship between the duration of sleep (short or long) and the likelihood of diabetes development. Another nine (23.68%) studies found that the sleep quality of individuals with diabetes was significantly poor [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan additionalcitationids=\"CR45 CR46 CR47\" citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e]. In particular, in six of these nine studies, it was determined that glycemic control variables were an important indicator [\u003cspan additionalcitationids=\"CR45 CR46 CR47 CR48\" citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to the results of three studies included in the research, it was found that diabetic neuropathic pain negatively affects sleep quality [\u003cspan additionalcitationids=\"CR42\" citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. In 10 (26.31%) of the studies included in the review, it was observed that obstructive sleep apnea, a sleep disorder, was significantly associated with diabetes [\u003cspan additionalcitationids=\"CR50 CR51 CR52\" citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e]. The results of two (5.26%) studies indicated that nighttime eating habits and poor sleep quality were also affected in individuals with T2DM [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e]. Only one (2.63%) study reported that the use of oral antidiabetic drugs positively affected sleep quality [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis systematic review highlights the effects of factors such as sleep duration, quality, sleep disorders, and obstructive sleep apnea (OSA) on the glycemic control and other diabetes-related metabolic parameters in individuals with T2DM. These 38 studies conducted between 1995 and 2025, across different geographical regions, demonstrate an increasing interest in the sleep-diabetes relationship over time, providing significant findings about the depth of this interaction. Limitations found in earlier studies (technological, sample size, methodology, etc.) are less prominent in recent years, with most studies utilizing robust methodological approaches and large sample sizes. This has enhanced the reliability of the results. Additionally, the methodological diversity and differences in sleep measurement techniques have led to some heterogeneity in the findings. This underscores the complexity of the relationship between sleep and diabetes, as well as the importance of individual differences.\u003c/p\u003e \u003cp\u003eThe sample size in the studies included in this systematic review ranged from 10 to 70,026. The wide range of sample sizes in the studies has increased the diversity of the findings and strengthened their generalizability. In terms of research design, 10.52% of the studies were longitudinal, 26.31% were cross-sectional, 23.68% were cohort studies, 26.31% were descriptive, and 13.15% were experimental. Different scales were selected based on the aim of each study, which enhanced the reliability of the data.\u003c/p\u003e \u003cp\u003eIn the studies that examined metabolic variables, 10 out of 30 studies (26.31%) addressed metabolic parameters [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan additionalcitationids=\"CR63\" citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e]. In these studies, glycemic control variables varied; five studies (13.15%) investigated fasting glucose [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e], 10 studies (26.31%) examined HbA1c [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan additionalcitationids=\"CR63\" citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e], one study (2.63%) assessed the glycemic index [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e], two studies (5.26%) focused on cholesterol [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e], and one study (2.63%) evaluated kidney function [\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe relationship between sleep duration and glycemic parameters is a frequently discussed topic in the literature. Among the 12 studies (31.57%) included in this systematic review, it was found that both very short (less than 6 hours) and very long (more than 9 hours) sleep durations lead to an increase in glucose intolerance, insulin resistance, and HbA1c levels [\u003cspan additionalcitationids=\"CR35 CR36 CR37 CR38 CR39 CR40 CR41 CR42 CR43 CR44\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Studies by Yaggi et al. (2006), Punjabi (2004), Gangwisch et al. (2007), and Meslier (2003) emphasize the impact of sleep duration on the metabolic health of individuals with diabetes [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. In a study by Jin (2012), a short sleep duration was particularly associated with negative effects on insulin secretion and β-cell function [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. These findings suggest a U-shaped relationship between sleep duration and metabolic health. That is, both very short sleep (\u0026lt;\u0026thinsp;6 hours) and very long sleep (\u0026gt;\u0026thinsp;9 hours) were found to be harmful to metabolic health. However, the U-shaped relationship observed in the studies included in this systematic review may vary by gender. For instance, the Ayas et al. (2003) study found that this relationship was only significant in male participants [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. These differing findings may help us understand how hormonal differences, lifestyle diversity, and gender-specific metabolic responses shape this relationship.\u003c/p\u003e \u003cp\u003eIn our study, the effect of sleep quality on glycemic control in individuals with diabetes emerges as one of the most important relationships. In nine studies (23.68%) included in our review, it was observed that the sleep quality of individuals with diabetes was significantly poor [\u003cspan additionalcitationids=\"CR35 CR36 CR37 CR38 CR39 CR40 CR41\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. In six of these studies (15.79%), poor glycemic control variables were found, with poor sleep quality being associated with increased HbA1c levels and poor glycemic control [\u003cspan additionalcitationids=\"CR37 CR38\" citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. Factors such as sleep fragmentation, frequent awakenings, and late bedtimes, which negatively affect sleep quality, complicate diabetes management. A study conducted by Trento (2008) highlighted that effective diabetes education not only improved glycemic control but also enhanced sleep quality, which had a positive impact on HbA1c levels [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. This indicates that in the effective management of diabetes, not only glycemic parameters but also quality of life should be considered.\u003c/p\u003e \u003cp\u003eThe diversity of sleep-related factors in individuals with diabetes points to the multifaceted elements affecting sleep quality. Studies focusing on neuropathic pain [\u003cspan additionalcitationids=\"CR35\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] show that such pain negatively affects sleep quality. Additionally, research demonstrating a significant relationship between obstructive sleep apnea and T2DM [\u003cspan additionalcitationids=\"CR38\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] emphasizes the mutual interaction of these conditions. Links between nocturnal eating habits\u003c/p\u003e \u003cp\u003eand poor sleep quality have also been highlighted in some studies [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Interestingly, only one study [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e] reported the positive effect of oral antidiabetics on sleep quality, suggesting that the potential secondary benefits of pharmacological treatments should be further investigated.\u003c/p\u003e \u003cp\u003eObstructive sleep apnea (OSA) is one of the sleep disorders that most negatively affects glycemic control in individuals with diabetes. Some of the studies included in our systematic review show that OSA leads to increased HbA1c levels, insulin resistance, and the development of T2DM [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e]. In addition to these findings, it has also been reported that more severe forms of OSA have more pronounced negative effects on metabolic health. Two studies reported that CPAP treatment for OSA management did not provide the expected level of improvement in glycemic control [\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e]. This finding suggests that issues with CPAP adherence and the timing of treatment initiation may limit its effects on glycemic control. Effective OSA treatment should not only improve sleep quality but also create broader impacts on diabetes management. To better understand the metabolic effects of OSA, it is necessary to have more detailed knowledge of how intermittent hypoxia and sympathetic activity contribute to disrupting glycemic control. For example, the effects of systemic inflammation and oxidative stress associated with OSA on metabolic health should be key focuses of research in this area. Furthermore, inconsistencies between different diagnostic methods for OSA (e.g., polysomnography, symptom questionnaires) affect the comparability of findings. This highlights the importance of standardizing diagnostic criteria.\u003c/p\u003e \u003cp\u003eThe impact of sleep patterns and quality on the self-management of diabetes in individuals is also one of the key points examined in this systematic review. Some studies included in the review report that individuals with sleep problems have reduced diabetes coping skills, lower levels of physical activity, and decreased adherence to treatment [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. Sadosky (2013) noted that complications of diabetes, such as neuropathic pain, negatively affect sleep patterns, leading to more complex effects on metabolic health [\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e]. This highlights that diabetes is not only a condition with physiological effects but also one that has psychosocial implications. In this context, treating individuals with diabetes while considering psychosocial factors (such as depression, anxiety, etc.) may result in a more successful treatment process.\u003c/p\u003e \u003cp\u003eThe effects of sleep duration, quality, and sleep disorders on metabolic health are consistent with the current literature and are supported by biological mechanisms. Spiegel et al. (2004) reported that insufficient sleep disrupts the balance of appetite-regulating hormones such as leptin and ghrelin, leading to insulin resistance [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Tasali et al. (2008) demonstrated that a lack of deep sleep negatively affects the secretion of growth hormone, causing disturbances in glucose metabolism [\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e]. Additionally, Punjabi et al. (2009) showed that intermittent hypoxia and increased sympathetic activity associated with OSA trigger systemic inflammation, impairing glycemic control [\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e]. These findings emphasize that sleep patterns have a multifaceted impact on diabetes management, and managing sleep problems in individuals with diabetes is crucial for metabolic health.\u003c/p\u003e \u003cp\u003eOur systematic review shows that the deterioration of sleep quality in individuals with T2DM negatively affects diabetes management and overall health. In a systematic review conducted by Abate et al. (2024), poor sleep quality was found to be prevalent in 48.54% of individuals with diabetes in Ethiopia. This prevalence rate is similar to the findings of studies included in our review, conducted in various countries. In our systematic review, nine studies (23.68%) found that sleep quality was significantly poor in individuals with T2DM, and particularly in 6 of these studies, significant associations were found between poor sleep quality and glycemic control variables. However, while Abate et al. (2024) focused solely on the prevalence of poor sleep quality, our study examined a broader range of sleep-related issues, including sleep quality, duration, disorders, and apneas, and assessed the relationships with metabolic variables [\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThe lack of standardization in the methods used to assess sleep quality in the studies included in our research (such as PSQI, subjective evaluation surveys, etc.) has limited the comparability of the findings. Moving forward, measuring sleep quality using more objective and reliable methods will allow for more robust results in future studies. In particular, further research on the relationship between sleep disorders (such as insomnia and parasomnias) and diabetes will be essential for gaining a deeper understanding of this connection. Furthermore, data inconsistencies may arise due to cultural, socioeconomic, and healthcare system differences. While this diversity ensures a broad scope of findings, the impact of methodological and regional factors should be carefully considered. Additionally, variations in sample size can create methodological inconsistencies. Therefore, it is crucial for future research to use more homogeneous sample groups to make the results more consistent.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe treatment of sleep disorders is crucial for improving diabetes management, and further research is needed in this area. Combining psychological treatments, sleep therapies, and lifestyle changes may enhance the positive effects on\u003c/p\u003e \u003cp\u003emetabolic health. In this context, future studies should focus on the detailed examination of the relationships between sleep disorder management and diabetes treatment. Improving sleep quality can potentially make diabetes management more effective.\u003c/p\u003e \u003cp\u003eAs a result, the relationship between sleep quality, sleep duration, and diabetes can both trigger metabolic disorders and contribute to the worsening of existing diabetes. This highlights the importance of not overlooking sleep disorders in diabetes treatment and suggests that improving sleep patterns could be a vital strategy for achieving better glycemic control in patients. Future research should explore the interactions between sleep, diabetes, and psychosocial factors more thoroughly, paving the way for the development of more effective treatment approaches.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eHuman and Animal Rights and Informed Consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis\u0026nbsp;article\u0026nbsp;does\u0026nbsp;not\u0026nbsp;contain\u0026nbsp;any\u0026nbsp;studies\u0026nbsp;with\u0026nbsp;human\u0026nbsp;or\u0026nbsp;animal\u0026nbsp;subjects\u0026nbsp;performed\u0026nbsp;by\u0026nbsp;any\u0026nbsp;of\u0026nbsp;the\u0026nbsp;authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDaya Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo datasets were generated or analysed during the current study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy Design: D.T.\u003c/p\u003e\n\u003cp\u003eSearch assessment of the articles: D.T., E.K.\u003c/p\u003e\n\u003cp\u003eInterpretation of the results, drafted sections: D.T., E.K., E.B.\u003c/p\u003e\n\u003cp\u003eRevision of the manuscript: E.K.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors approved the final copy of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eT\u0026uuml;rkiye Cumhuriyeti Sağlık Bakanlığı (2011) \u003cem\u003eT\u0026uuml;rkiye Diyabet \u0026Ouml;nleme ve Kontrol Programı 2011\u0026ndash;2020\u003c/em\u003e. Sağlık Bakanlığı Yayınlar\u0026amp;#305\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSatman I, Yılmaz T, Tutuncu Y (2002) Population-based study of diabetes and risk characteristics in Turkey: Results of the Turkish Diabetes Epidemiology Study (TURDEP). Diabetes Care 25(9):1551\u0026ndash;1556. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2337/diacare.25.9.1551\u003c/span\u003e\u003cspan address=\"10.2337/diacare.25.9.1551\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTurkish Endocrinology and Metabolism Society (2014) Clinical guidelines for endocrine disorders. Turkish Endocrinology and Metabolism Society\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKnutson KL, Spiegel K, Penev P, Van Cauter E (2007) The metabolic consequences of sleep deprivation. Sleep Med Rev 11(3):163\u0026ndash;178. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.smrv.2007.01.002\u003c/span\u003e\u003cspan address=\"10.1016/j.smrv.2007.01.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLim LL, Foldvary-Schaefer N (2010) Sleep disorders. In: Tavee J (ed) Current clinical medicine. Elsevier Health Sciences, pp 914\u0026ndash;915\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHernandez A, Philippe J, Jornayvaz FR (2012) Sleep and diabetes. Revue M\u0026eacute;dicale Suisse 8(344):1198\u0026ndash;1200\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKline CE, Irish LA, Krafty RT, Sternfeld B, SWAN Study Group (2013) Consistently high sports/exercise activity is associated with better sleep quality, continuity, and depth in midlife women: The SWAN Sleep Study. Sleep 36(9):1279\u0026ndash;1288. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5665/sleep.2928\u003c/span\u003e\u003cspan address=\"10.5665/sleep.2928\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuysse DJ, Reynolds CF, Monk TH, Berman SS, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res 28(2):193\u0026ndash;213. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/0165-1781(89)90047-4\u003c/span\u003e\u003cspan address=\"10.1016/0165-1781(89)90047-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan Cauter E, Knutson K, Leproult R, Spiegel K (2005) The impact of sleep deprivation on hormones and metabolism. Medscape Neurol, \u003cem\u003e7\u003c/em\u003e(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.medscape.com/viewarticle/500632\u003c/span\u003e\u003cspan address=\"https://www.medscape.com/viewarticle/500632\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBonnet MH, Arand DL (1995) We are chronically sleep deprived. Sleep 18(9):908\u0026ndash;911\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Academy of Sleep Medicine (AASM) (2007) International classification of sleep disorders, 2nd edn. American Academy of Sleep Medicine\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNational Center for Health Statistics (2005) \u003cem\u003eNational Health Interview Survey, 2005\u003c/em\u003e. Centers for Disease Control and Prevention. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cdc.gov/nchs/nhis.htm\u003c/span\u003e\u003cspan address=\"https://www.cdc.gov/nchs/nhis.htm\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDemir A (2010) T\u0026uuml;rkiye'de erişkin toplumda uyku epidemiyolojisi \u0026ccedil;alışması ilk sonu\u0026ccedil;ları 2010. T\u0026uuml;rkiye: T\u0026uuml;rk Tıbbi Uyku Derneği Yayını; 2010\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan Cauter E, Polonsky KS, Scheen AJ (1997) Roles of circadian rhythmicity and sleep in human glucose regulation. Endocr Rev 18(5):716\u0026ndash;738. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1210/edrv.18.5.0317\u003c/span\u003e\u003cspan address=\"10.1210/edrv.18.5.0317\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan Cauter E, Blackman JD, Roland D, Spire JP (1991) \u0026amp; colleagues. Modulation of glucose regulation and insulin secretion by circadian rhythmicity and sleep. \u003cem\u003eThe Journal of Clinical Investigation, 88\u003c/em\u003e(3), 934\u0026ndash;942. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1172/JCI115070\u003c/span\u003e\u003cspan address=\"10.1172/JCI115070\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan Cauter E, Spiegel K, Tasali E, Leproult R (2008) Metabolic consequences of sleep and sleep loss. Sleep Med 9(Suppl 1):S23\u0026ndash;S28. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.sleep.2008.01.001\u003c/span\u003e\u003cspan address=\"10.1016/j.sleep.2008.01.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan Cauter E, Holmback U, Knutson K, Leproult R (2007) \u0026amp; colleagues. Impact of sleep and sleep loss on neuroendocrine and metabolic function. \u003cem\u003eHormone Research, 67\u003c/em\u003e(Suppl 1), 2\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1159/000096711\u003c/span\u003e\u003cspan address=\"10.1159/000096711\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpiegel K, Leproult R, Van Cauter E (1999) Impact of sleep debt on metabolic and endocrine function. Lancet 354(9188):1435\u0026ndash;1439. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S0140-6736(99)01376-8\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(99)01376-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYildiz BO, Suchard MA, Wong M-L, McCann SM, Licinio J (2004) Alterations in the dynamics of circulating ghrelin, adiponectin, and leptin in human obesity. Proc Natl Acad Sci USA 101(28):10434\u0026ndash;10439. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1073/pnas.0403465101\u003c/span\u003e\u003cspan address=\"10.1073/pnas.0403465101\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStamatakis KA, Punjabi NM (2010) Effects of sleep fragmentation on glucose metabolism in normal subjects. Chest 137(1):95\u0026ndash;101. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1378/chest.09-1457\u003c/span\u003e\u003cspan address=\"10.1378/chest.09-1457\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpiegel K, Leproult R, L\u0026rsquo;Hermite-Bal\u0026eacute;riaux M, Copinschi G (2004) \u0026amp; colleagues. Leptin levels are dependent on sleep duration: Relationships with sympathovagal balance, carbohydrate regulation, cortisol, and thyrotropin. \u003cem\u003eThe Journal of Clinical Endocrinology \u0026amp; Metabolism, 89\u003c/em\u003e(11), 5762\u0026ndash;5771. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1210/jc.2004-0364\u003c/span\u003e\u003cspan address=\"10.1210/jc.2004-0364\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVgontzas AN, Mastorakos G, Bixler EO, Kales A (1999) \u0026amp; colleagues. Sleep deprivation effects on the activity of the hypothalamic-pituitary-adrenal and growth axes: Potential clinical implications. \u003cem\u003eClinical Endocrinology, 51\u003c/em\u003e(2), 205\u0026ndash;215. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1046/j.1365-2265.1999.00951.x\u003c/span\u003e\u003cspan address=\"10.1046/j.1365-2265.1999.00951.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIrwin M, Thompson J, Miller C, Gillin JC (1999) \u0026amp; colleagues. Effects of sleep and sleep deprivation on catecholamine and interleukin-2 levels in humans: Clinical implications. \u003cem\u003eThe Journal of Clinical Endocrinology \u0026amp; Metabolism, 84\u003c/em\u003e(6), 1979\u0026ndash;1985. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1210/jcem.84.6.5776\u003c/span\u003e\u003cspan address=\"10.1210/jcem.84.6.5776\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSomers VK, Dyken ME, Clary MP, Abboud FM (1995) Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Investig 96(4):1897\u0026ndash;1904. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1172/JCI118942\u003c/span\u003e\u003cspan address=\"10.1172/JCI118942\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKessler L, Nedeltcheva A, Imperial J, Penev PD (2010) Changes in serum TSH and free T4 during human sleep restriction. Sleep 33(8):1115\u0026ndash;1118. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/sleep/33.8.1115\u003c/span\u003e\u003cspan address=\"10.1093/sleep/33.8.1115\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLucassen EA, Rother KI, Cizza G (2012) Interacting epidemics? Sleep curtailment, insulin resistance, and obesity. Ann N Y Acad Sci 1264(1):110\u0026ndash;134. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1749-6632.2012.06655.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1749-6632.2012.06655.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTaub LF, Redeker NS (2008) Sleep disorders, glucose regulation, and T2DM. Biol Res Nurs 9(3):231\u0026ndash;243. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/1099800408320656\u003c/span\u003e\u003cspan address=\"10.1177/1099800408320656\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKnutson KL, Van Cauter E (2008) Associations between sleep loss and increased risk of obesity and diabetes. Ann N Y Acad Sci 1129:287\u0026ndash;304. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1196/annals.1417.033\u003c/span\u003e\u003cspan address=\"10.1196/annals.1417.033\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Diabetes Association (2014) Standards of medical care in diabetes\u0026mdash;2014. Diabetes Care 37(Suppl 1):S14\u0026ndash;S80. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2337/dc14-S014\u003c/span\u003e\u003cspan address=\"10.2337/dc14-S014\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTurkish Endocrinology and Metabolism Society (2014) Diabetes mellitus tanı ve tedavi rehberi [Diabetes mellitus diagnosis and treatment guide]. TEMD\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInternational Diabetes Federation (2014) IDF diabetes atlas, 6th edn. International Diabetes Federation\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKalav S, Altın-\u0026Ccedil;etin A, Bektaş H (2020) The effect of oral hygiene practices in stroke patients: A systematic review. Turkiye Klinikleri J Nurs Sci 12(3):430\u0026ndash;442. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5336/nurses.2020-74729\u003c/span\u003e\u003cspan address=\"10.5336/nurses.2020-74729\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBağria\u0026ccedil;ik E, Bayraktar N (2022) Effectiveness of training in disease management for patients with T2DM mellitus: A systematic review. Endocrinolog\u0026iacute;a, Diabetes y Nutrici\u0026oacute;n (English ed. 69(5):362\u0026ndash;378. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.endien.2022.02.001\u003c/span\u003e\u003cspan address=\"10.1016/j.endien.2022.02.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNakajima, H.,Kaneita, Y., Yokoyama, E., Harano, S., Tamaki, T., Ibuka, E., \u0026hellip; \u0026amp; Ohida, T. (2008). Association between sleep duration and hemoglobin A1c level. Sleep Medicine,9(7), 745\u0026ndash;752. https://doi.org/10.1016/j.sleep.2007.10.004\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCunha MCBD, Zanetti ML, Hass VJ (2008) Sleep quality in type 2 diabetics. Revista Latino- Americana de Enfermagem 16(5):850\u0026ndash;855. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1590/S0104-11692008000500012\u003c/span\u003e\u003cspan address=\"10.1590/S0104-11692008000500012\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGangwisch, J. E., Heymsfield, S. B., Boden-Albala, B., Buijs, R. M., Kreier, F., Pickering,T. G., \u0026hellip; Malaspina,D. (2007). Sleep duration as a risk factor for diabetes incidence in a large US sample. Sleep, 30(12), 1667\u0026ndash;1673. https://doi.org/10.1093/sleep/30.12.1667\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYaggi HK, Araujo AB, McKinlay JB (2006) Sleep duration as a risk factor for the development of T2DM. Diabetes Care 29(3):657\u0026ndash;661. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2337/dc05-0981\u003c/span\u003e\u003cspan address=\"10.2337/dc05-0981\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGottlieb DJ, Punjabi NM, Newman AB, Resnick HE, Redline S, Baldwin CM, Nieto FJ (2005) Association of sleep time with diabetes mellitus and impaired glucose tolerance. Arch Intern Med 165(8):863\u0026ndash;867. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1001/archinte.165.8.863\u003c/span\u003e\u003cspan address=\"10.1001/archinte.165.8.863\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeisinger C, Heier M, Loewel H (2005) Sleep disturbance as a predictor of T2DM mellitus in men and women from the general population: Results from the MONICA/KORA Augsburg Cohort Study. Diabetologia 48(2):235\u0026ndash;241. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00125-004-1644-7\u003c/span\u003e\u003cspan address=\"10.1007/s00125-004-1644-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAyas, N.T., White, D. P., Al-Delaimy, W. K., Manson, J. E., Stampfer, M. J., Speizer, F. E., \u0026hellip; \u0026amp; Hu, F. B. (2003). A prospective study of self-reported sleep duration and incident diabetes in women. Diabetes Care, 26(2),380\u0026ndash;384. https://doi.org/10.2337/diacare.26.2.380\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSadosky A, Hopper J, Parsons B (2014) Painful diabetic peripheral neuropathy: Results of a survey characterizing the perspectives and misperceptions of patients and healthcare practitioners. Patient - Patient-Centered Outcomes Res 7(2):107\u0026ndash;114. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s40271-014-0045-4\u003c/span\u003e\u003cspan address=\"10.1007/s40271-014-0045-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZelman DC, Brandenburg NA, Gore M (2006) Sleep impairment in patients with painful diabetic peripheral neuropathy. Clin J Pain 22(8):681\u0026ndash;685. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/01.ajp.0000239723.13221.2b\u003c/span\u003e\u003cspan address=\"10.1097/01.ajp.0000239723.13221.2b\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGore M, Brandenburg NA, Dukes E, Hoffman DL, Tai K-S, Stacey B (2005) Pain severity in diabetic peripheral neuropathy is associated with patient functioning, symptom levels of anxiety and depression, and sleep. J Pain Symptom Manag 30(4):374\u0026ndash;385. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jpainsymman.2005.04.009\u003c/span\u003e\u003cspan address=\"10.1016/j.jpainsymman.2005.04.009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJin QH, Chen HH, Yu HL, Li TL (2012) The relationship between sleep quality and glucose level, diabetic complications in elderly T2DM mellitus. Zhonghua nei ke za zhi 51(5):357\u0026ndash;361 PMID: 22883333\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTsai Y-W, Kann N-H, Tung T-H, Chao Y-J, Lin C-J, Chang K-C, Chang S-S, Chen J-Y (2012) Associations of health literacy and sleep problems with chronic disease in Taiwanese adults. Fam Pract 29(1):30\u0026ndash;35. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/fampra/cmr041\u003c/span\u003e\u003cspan address=\"10.1093/fampra/cmr041\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNakanishi-Minami T, Kishida K, Funahashi T, Shimomura I (2012) Sleep-wake cycle irregularities in type 2 diabetics. Diabetol Metab Syndr., 4, Article 18 \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/1758-5996-4-18\u003c/span\u003e\u003cspan address=\"10.1186/1758-5996-4-18\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuyster FS, Dunbar-Jacob J (2011) Sleep quality and quality of life in adults with T2DM. Diabetes Educ 37(3):347\u0026ndash;355. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0145721711406137\u003c/span\u003e\u003cspan address=\"10.1177/0145721711406137\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTrento, M., Broglio, F., Riganti, F., Basile, M., Borgo, E., Kucich, C.,\u0026hellip; Porta, M. (2008). Sleep abnormalities in T2DM may be associated with glycemic control. Acta Diabetologica, 45(3), 225\u0026ndash;229. https://doi.org/10.1007/s00592-007-0073-5\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKosseifi S, Bailey B, Price R, Roy TM, Byrd RP Jr., Peiris AN (2010) The association between obstructive sleep apnea syndrome and microvascular complications in well-controlled diabetic patients. Mil Med 175(11):913\u0026ndash;916. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.7205/MILMED-D-09-00355\u003c/span\u003e\u003cspan address=\"10.7205/MILMED-D-09-00355\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeslier N, Gagnadoux F, Giraud P, Person C, Ouksel H, Urban T, Racineux JL (2003) Impaired glucose-insulin metabolism in males with obstructive sleep apnoea syndrome. Eur Respir J 22(1):156\u0026ndash;160. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1183/09031936.03.00048502\u003c/span\u003e\u003cspan address=\"10.1183/09031936.03.00048502\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElmasry A, Lindberg E, Berne C, Janson C, Gislason T, Awad TM, Boman G (2001) Sleep- disordered breathing and glucose metabolism in hypertensive men: A population-based study. J Intern Med 249(2):153\u0026ndash;161. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1046/j.1365-2796.2001.00894.x\u003c/span\u003e\u003cspan address=\"10.1046/j.1365-2796.2001.00894.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePunjabi NM, Shahar E, Redline S, Gottlieb DJ, Givelber R, Resnick HE (2004) Sleep- disordered breathing, glucose intolerance, and insulin resistance: The Sleep Heart Health Study. Am J Epidemiol 160(6):521\u0026ndash;530. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/aje/kwh261\u003c/span\u003e\u003cspan address=\"10.1093/aje/kwh261\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSomers VK, Dyken ME, Clary MP, Abboud FM (1995) Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Investig 96(4):1897\u0026ndash;1904. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1172/JCI118235\u003c/span\u003e\u003cspan address=\"10.1172/JCI118235\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOhkuma, T., Fujii, H., Iwase, M., Ogata-Kaizu, S., Ide, H., Kikuchi, Y., \u0026hellip;Kitazono, T. (2014). U-shaped association of sleep duration with metabolic syndrome and insulin resistance in patients with T2DM: The Fukuoka Diabetes Registry. Metabolism, 63(4), 484\u0026ndash;491. https://doi.org/10.1016/j.metabol.2013.12.006\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHood MM, Reutrakul S, Crowley SJ (2014) Night eating in patients with T2DM: Associations with glycemic control, eating patterns, sleep, and mood. Appetite 79:91\u0026ndash;96. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.appet.2014.04.005\u003c/span\u003e\u003cspan address=\"10.1016/j.appet.2014.04.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTare,A., Lane, J. M., Cade, B. E., Grant, S. F., Chen, T. H., Punjabi, N. M., \u0026hellip; \u0026amp; Saxena, R. (2014). Sleep duration does not mediate or modify association of common genetic variants with T2DM. Diabetologia, 57, 339\u0026ndash;346. https://doi.org/10.1007/s00125-013-3098-7\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTanno,S., Tanigawa, T., Saito, I., Nishida, W., Maruyama, K., Eguchi, E., \u0026hellip; Punjabi, N. M. (2014). Sleep- related intermittent hypoxemia and glucose intolerance: A community-based study.Sleep Medicine, 15(10), 1212\u0026ndash;1218. https://doi.org/10.1016/j.sleep.2014.05.019\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKajbaf F, Fendri S, Basille-Fantinato A, Diouf M, Rose D, Jounieaux V, Lalau J-D (2014) The relationship between metformin therapy and sleep quantity and quality in patients with T2DM referred for potential sleep disorders. Diabet Med 31(5):577\u0026ndash;580. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/dme.12362:contentReference[oaicite:7]{index=7}\u003c/span\u003e\u003cspan address=\"10.1111/dme.12362:contentReference[oaicite:7]{index=7}\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCosta EG, Campos RP, Costa EC (2014) Relationship between socio demographic, clinical and psychosocial variables in patients with T2DM. An\u0026aacute;lise Psicol\u0026oacute;gica 32(1):63\u0026ndash;77. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.14417/ap.734\u003c/span\u003e\u003cspan address=\"10.14417/ap.734\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eObaseki DO, Kolawole BA, Gomerep SS, Obaseki JE, Abidoye IA, Ikem RT, Erhabor GE (2014) Prevalence and predictors of obstructive sleep apnea syndrome in a sample of patients with T2DM mellitus in Nigeria. Nigerian Med J 55(1):24\u0026ndash;28. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4103/0300- 1652.126291\u003c/span\u003e\u003cspan address=\"10.4103/0300- 1652.126291\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLai Y-J, Lin C-L, Lin M-C, Lee S-T, Sung F-C, Chang Y-J, Kao C-H (2013) Population-based cohort study on the increase in the risk for T2DM mellitus development from nonapnea sleep disorders. Sleep Med 14(9):913\u0026ndash;918. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.sleep.2013.03.024\u003c/span\u003e\u003cspan address=\"10.1016/j.sleep.2013.03.024\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSong Y, Ye X, Ye L, Li B, Wang L, Hua Y (2013) Disturbed subjective sleep in Chinese females with T2DM on insulin therapy. PLoS ONE 8(1):e54951. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0054951\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0054951\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSt-Onge M-P, Zammit G, Reboussin DM, Kuna ST, Sanders MH, Millman R, Newman AB, Wadden TA, Wing RR, Pi-Sunyer FX, Foster GD, Sleep AHEAD Research Group (2012) Associations of sleep disturbance and duration with metabolic risk factors in obese persons with T2DM: Data from the Sleep AHEAD Study. Nat Sci Sleep 4:143\u0026ndash;150. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2147/NSS.S35797\u003c/span\u003e\u003cspan address=\"10.2147/NSS.S35797\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuyukaydin B, Akkoyunlu ME, Kazancioglu R, Karakose F, Ozcelik HK, Erkoc R, Kart L (2012) The effect of sleep apnea syndrome on the development of diabetic nephropathy in patients with T2DM. Diabetes Res Clin Pract 98(1):140\u0026ndash;143. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.diabres.2012.08.011\u003c/span\u003e\u003cspan address=\"10.1016/j.diabres.2012.08.011\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCros, J., Pianezzi,E., Rosset, R., Egli, L., Schneiter, P., Cornette, F., \u0026hellip; Lecoultre, V. (2019). Impact of sleep restriction on metabolic outcomes induced by overfeeding: A randomized controlled trial in healthy individuals. The American Journal of Clinical Nutrition, 109(1), 17\u0026ndash;28. https://doi.org/10.1093/ajcn/nqy255\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRadcliffe PN, Whitney CC, Fagnant HS, Wilson MA, Finlayson G, Smith TJ, Karl JP (2021) Severe sleep restriction suppresses appetite independent of effects on appetite regulating hormones in healthy young men without obesity. Physiol Behav 237:113438. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.physbeh.2021.113438\u003c/span\u003e\u003cspan address=\"10.1016/j.physbeh.2021.113438\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTajiri E, Yoshimura E, Hatamoto Y, Tanaka H, Shimoda S (2018) Effect of sleep curtailment on dietary behavior and physical activity: A randomized crossover trial. Physiol Behav 184:60\u0026ndash;67. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.physbeh.2017.11.002\u003c/span\u003e\u003cspan address=\"10.1016/j.physbeh.2017.11.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbdissa D (2020) Prevalence of obstructive sleep apnea risk and associated factors among patients with T2DM mellitus on follow-up at Jimma Medical Center, Southwest Ethiopia. J Clin Translational Endocrinol 21:100234. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jcte.2020.100234\u003c/span\u003e\u003cspan address=\"10.1016/j.jcte.2020.100234\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang X, Greer J, Porter R, Kaur K, Youngstedt S, Fayad R (2015) Short-term moderate sleep restriction increases insulin concentration following oral glucose tolerance test. FASEB J 29(2):805\u0026ndash;809. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1096/fj.14-263947\u003c/span\u003e\u003cspan address=\"10.1096/fj.14-263947\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang J, Yang C, An J, Fan Y, Dong X, Brain (2025) Behav Immun - Health, 100953. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.bbih.2024.100953\u003c/span\u003e\u003cspan address=\"10.1016/j.bbih.2024.100953\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrimaldi D, Beccuti G, Touma C, Van Cauter E, Mokhlesi B (2014) Association of obstructive sleep apnea in rapid eye movement sleep with reduced glycemic control in T2DM: Therapeutic implications. Diabetes Care 37(2):355\u0026ndash;363. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2337/dc13-109672\u003c/span\u003e\u003cspan address=\"10.2337/dc13-109672\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWest SD, Nicoll DJ, Wallace TM, Matthews DR, Stradling JR (2007) Effect of CPAP on insulin resistance and HbA1c in men with obstructive sleep apnoea and T2DM. Thorax 62(11):969\u0026ndash;974. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/thx.2006.06643873\u003c/span\u003e\u003cspan address=\"10.1136/thx.2006.06643873\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSadosky A, Schaefer C, Mann R, Bergstrom F, Baik R, Parsons B, Nalamachu S, Nieshoff E, Stacey BR, Anschel A, Tuchman M (2013) Burden of illness associated with painful diabetic peripheral neuropathy among adults seeking treatment in the US: Results from a retrospective chart review and cross-sectional survey. Diabetes Metabolic Syndrome Obesity: Targets Therapy 6:79\u0026ndash;92. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2147/DMSO.S37415\u003c/span\u003e\u003cspan address=\"10.2147/DMSO.S37415\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTasali E, Leproult R, Ehrmann DA, Van Cauter E (2008) Slow-wave sleep and the risk of T2DM in humans. \u003cem\u003eProceedings of the National Academy of Sciences, 105\u003c/em\u003e(3), 1044\u0026ndash;1049. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1073/pnas.0706446105\u003c/span\u003e\u003cspan address=\"10.1073/pnas.0706446105\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePunjabi NM, Beamer BA, Zhang Y (2009) Effects of acute intermittent hypoxia on glucose metabolism in awake healthy volunteers. J Appl Physiol 106(5):1538\u0026ndash;1544. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1152/japplphysiol.91523.2008\u003c/span\u003e\u003cspan address=\"10.1152/japplphysiol.91523.2008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbate HK, Azagew AW, Nega GA, Birru SM, Mekonnen CK (2024) Prevalence and determinants of poor sleep quality among diabetic patients in Ethiopia: Systematic review. Front Public Health 12:1363408. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpubh.2024.1363408\u003c/span\u003e\u003cspan address=\"10.3389/fpubh.2024.1363408\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Near East University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Adults, Metabolic variables, Sleep quality, Systematic review, Type 2 diabetes","lastPublishedDoi":"10.21203/rs.3.rs-6820219/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6820219/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThis systematic review was conducted by including recent studies in the literature that examine the relationship between sleep quality and metabolic parameters in individuals with type 2 diabetes.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eThe aim was to contribute to the literature by evaluating studies that investigate the impact of sleep quality on metabolic variables in individuals with type 2 diabetes.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eResearch indexed in international databases between 1995 and 2025 and meeting specified criteria was included. Sleep quality was assessed based on factors such as duration, continuity, sleep onset latency, and individual satisfaction with sleep. The studies were also analyzed and compared according to glycemic control variables (HbA1c levels), which are considered to be influenced by sleep. A total of 38 studies meeting the criteria were included after screening seven databases.\u003c/p\u003e\u003ch2\u003eFindings\u003c/h2\u003e \u003cp\u003eThe findings indicate that insufficient and poor-quality sleep is generally associated with elevated HbA1c levels, impaired glucose tolerance, increased insulin resistance, and adverse lipid profiles. Furthermore, some studies have reported that sleep disorders may negatively affect the course of diabetes by contributing to increased inflammatory markers.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe findings suggest that sleep quality is an important lifestyle factor to consider in the management of type 2 diabetes. They also underscore the importance of healthcare professionals integrating sleep assessments and interventions into clinical practice for individuals with diabetes.\u003c/p\u003e","manuscriptTitle":"A Systematic Review of Studies Investigating the Impact of Sleep Quality on Metabolic Variables in Individuals With T2DM","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-05 04:08:48","doi":"10.21203/rs.3.rs-6820219/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6aac8407-5119-45d8-9cff-8bb6fde9dc1d","owner":[],"postedDate":"June 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":49521386,"name":"Endocrinology \u0026 Metabolism"},{"id":49521387,"name":"Nursing"},{"id":49521388,"name":"Physical Medicine \u0026 Rehab"}],"tags":[],"updatedAt":"2025-06-05T04:08:49+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-05 04:08:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6820219","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6820219","identity":"rs-6820219","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}