Effectiveness of cognitive behavior therapy for sleep disturbance and glycemic control in persons with type 2 diabetes mellitus:A community-based randomized controlled trial in China

BACKGROUND Poor sleep quality is a common clinical feature in patients with type 2 diabetes mellitus(T2DM),and often negatively related with glycemic control.Cognitive behavioral therapy(CBT)may improve sleep quality and reduce blood sugar levels in patients with T2DM.However,it is not entirely clear whether CBT delivered by general practitioners is effective for poor sleep quality in T2DM patients in community settings.AIM To test the effect of CBT delivered by general practitioners in improving sleep quality and reducing glycemic levels in patients with T2DM in community.METHODS A cluster randomized controlled trial was conducted from September 2018 to October 2019 in communities of China.Overall 1033 persons with T2DM and poor sleep quality received CBT plus usual care or usual care.Glycosylated hemoglobin A1c(HbAlc)and sleep quality[Pittsburgh Sleep Quality Index(PSQI)]were assessed.Repeated measures analysis of variance and generalized linear mixed effects models were used to estimate the intervention effects on hemoglobin A1c and sleep quality.RESULTS The CBT group had 0.64,0.50,and 0.9 lower PSQI scores than the control group at 2 mo,6 mo,and 12 mo,respectively.The CBT group showed 0.17 and 0.43 lower HbAlc values than the control group at 6 mo and 12 mo.The intervention on meanΔHbAlc values was significant at 12 mo(t=3.68,P<0.01)and that meanΔPSQI scores were closely related toΔHbAlc values(t=7.02,P<0.01).Intentionto-treat analysis for primary and secondary outcomes showed identical results with completed samples.No adverse events were reported.CONCLUSION CBT delivered by general practitioners,as an effective and practical method,could reduce glycemic levels and improve sleep quality for patients with T2DM in community.

The interaction effect of grip strength and lung function (especially FVC) on cardiovascular diseases: a prospective cohort study in Jiangsu Province, China

OBJECTIVE Lung function and grip strength(GS)are associated with cardiovascular disease(CVD),but whether these risk factors interact to affect CVD is unknown.This study aimed to explore the interactions between lung function and GS with major CVD(defined as fatal/non-fatal myocardial infarction,stroke,and heart failure)incidence.METHODS We conducted a prospective cohort study on the Chinese population in Jiangsu Province.Cox proportional haz-ards models were used to explore the associations between GS,lung function,and major CVD incidence.RESULTS A total of 5967 participants were included in our study;among them,182 participants developed major CVD.Parti-cipants with low forced vital capacity(FVC)had a higher risk of major CVD(hazard ratio(HR)=1.45;95%confidence interval(CI):1.05-2.01;P<0.05)compared with normal FVC.The risk of major CVD incidence(HR=0.54;95%CI:0.35-0.83;P<0.01)was significantly lower in participants with high GS than in individuals with low GS.The interaction between FVC and GS for major CVD incidence(P=0.006)was statistically significant.Compared with normal FVC participants with high GS,low FVC parti-cipants with low GS had the highest risk of major CVD incidence(HR=2.50;95%CI:1.43-4.36;P<0.01).CONCLUSION Among people with low FVC,the risk of major CVD is lower with high GS.Participants with low FVC and low GS have the highest risk of major CVD.Therefore,more attention should be paid to the incidence of major CVD in individu-als with low FVC,especially those who have lower GS.