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

Sleep disturbances are highly prevalent in individuals with diabetes and are associated with various adverse physiological, psychological, and social consequences. A growing body of research supports the effectiveness of cognitive behavioral therapy (CBT) in managing sleep problems in diabetes. However, the extent of its positive correlation with sleep quality and glycemic outcomes remains unclear due to the lack of rigorous evidence synthesis.

Ten databases (PubMed, Cochrane Library, EMBASE, CINAHL, Web of Science, MEDLINE, APA PsycInfo, China National Knowledge Infrastructure [CNKI], Wanfang Data Knowledge Service Platform, VIP) were searched using keywords related to cognitive behavioral therapy and diabetes, from their inception until June 2026, to identify eligible randomized controlled trials. Researchers independently screened and extracted data from the included studies. The risk of bias was assessed using the Cochrane Risk of Bias tool (RoB 2.0). Random-effects meta-analyses were performed using Review Manager software (RevMan) 5.4.1 to estimate overall effects and for prespecified subgroup analyses. Sensitivity analysis, assessment of publication bias, and meta-regression were conducted using STATA 17.0 to explore study-level variables potentially contributing to heterogeneity.