Sleep-AID: a cross-sectional analysis of subjective sleep quality, psychosocial measures and real-world glycemic outcomes in people with diabetes using automated insulin delivery systems
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2026
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Abstract
Abstract Study Objectives Sleep disturbances are common in people with diabetes, yet their relationship to automated insulin delivery (AID) use has not been well described in large, real-world cohorts. We assessed subjective sleep quality, fear of hypoglycemia, and their associations with glycemic outcomes among adults with diabetes using open-source and commercial AID compared with non-users. Methods We conducted a cross-sectional analysis of 529 adults from the OPEN Project (2020–2023). Participants completed the Pittsburgh Sleep Quality Index (PSQI) and Hypoglycemia Fear Survey-II (HFS-II) short form. All participants self-reported glycated hemoglobin (HbA1c) levels; a subsample of 60 AID users contributed ≥25 days of continuous glucose monitoring (CGM) data. Free-text responses to PSQI item 5j were thematically coded. Results AID users reported better sleep (median 5 [IQR 3–7] vs. 7 [IQR 5–9], p < .001) and lower fear of hypoglycemia (median 7 [IQR 3–11] vs. 13 [IQR 8–19], p < .001) than non-users. Nevertheless, 43% of AID users and 69% of non-users exceeded poor sleep thresholds. Women reported worse PSQI and HFS-II scores than men (both p < .001). Diabetes-related causes of sleep disruption were more common among non-users (p < .05). PSQI and HFS-II scores correlated with HbA1c in the subsample, but associations with CGM metrics were not significant. Conclusions Adults using AID systems reported better sleep quality and lower fear of hypoglycemia than those managing diabetes without automation, yet a large proportion of all participants continued to experience poor sleep. Diabetes-related nocturnal disruptions remained common among non-users, suggesting that AID may alleviate—but not eliminate—the nighttime diabetes burden.
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| Authors | Drew Cooper, Tebbe Ubben, Christine Knoll, Christine Blume, Wolf‐Julian Neumann, Katarina Braune |
| Journal | SLEEP Advances |
| Year | 2026 |
| DOI |
10.1093/sleepadvances/zpag066
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| URL | |
| Keywords | Keywords not found |
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