Type 2 diabetes mellitus (T2DM) had emerged as one of the most prevalent chronic metabolic disorders worldwide and had become a major public health concern because of its increasing incidence, long-term complications, and substantial impact on patients' quality of life. It was characterized by insulin resistance and progressive impairment of pancreatic beta-cell function, which resulted in persistent hyperglycemia. The increasing prevalence of T2DM had been associated with several factors, including sedentary lifestyles, unhealthy dietary habits, obesity, genetic susceptibility, and population aging [1]. Poor glycemic control had significantly increased the risk of microvascular and macrovascular complications, including diabetic nephropathy, retinopathy, neuropathy, cardiovascular diseases, and cerebrovascular events. Therefore, effective diabetes management had required not only appropriate pharmacological treatment but also attention to lifestyle factors that influenced metabolic health.

Sleep quality had received considerable attention as an important behavioral and physiological factor associated with glucose metabolism [2]. Adequate sleep had played an essential role in maintaining hormonal balance, regulating energy metabolism, and supporting normal insulin sensitivity. However, patients with T2DM frequently experienced sleep disturbances, including difficulty initiating or maintaining sleep, frequent nighttime awakenings, early morning awakening, and excessive daytime sleepiness. These disturbances had been attributed to several diabetes-related factors, such as nocturia, peripheral neuropathic pain, nocturnal hypoglycemia, hyperglycemia, and associated psychological stress [3]. In addition, obesity, obstructive sleep apnea, depression, and other comorbid conditions had further contributed to poor sleep quality among diabetic individuals.

Previous research had suggested that inadequate sleep duration and poor sleep quality had adversely affected glucose metabolism through multiple physiological mechanisms. Sleep deprivation had been associated with increased sympathetic nervous system activity, elevated cortisol secretion, inflammatory responses, and impaired insulin sensitivity. These physiological alterations had contributed to increased blood glucose levels and deterioration in glycemic regulation [4]. Furthermore, sleep disturbances had influenced appetite-regulating hormones, including leptin and ghrelin, which had potentially promoted increased food intake, weight gain, and metabolic dysfunction. Consequently, persistent sleep disturbances had been considered an important potential contributor to poor glycemic control among individuals with T2DM.

Glycemic control had represented a fundamental component of diabetes management and had commonly been assessed through glycated hemoglobin (HbA1c), fasting blood glucose, and postprandial blood glucose measurements [5]. Among these parameters, HbA1c had provided an estimate of average blood glucose levels over approximately two to three months and had been widely used to evaluate long-term metabolic control. Several investigations had reported an association between poor sleep quality and elevated HbA1c levels. Patients experiencing inadequate sleep had frequently demonstrated poorer adherence to medication, reduced physical activity, unhealthy dietary patterns, and difficulties maintaining recommended self-care practices. These behavioral factors had further complicated diabetes management and had potentially contributed to inadequate glycemic control [6].

Assessment of sleep quality had therefore been considered an important aspect of comprehensive diabetes care. The Pittsburgh Sleep Quality Index (PSQI) had been widely utilized to evaluate subjective sleep quality through different components, including sleep duration, sleep latency, sleep efficiency, sleep disturbances, and daytime dysfunction. Its application had facilitated the identification of patients experiencing poor sleep quality who might otherwise have remained undiagnosed during routine diabetes consultations [7]. Early recognition of sleep-related problems had offered opportunities for appropriate counseling, lifestyle modifications, and targeted interventions to improve overall diabetes management.

Despite increasing recognition of the relationship between sleep disturbances and metabolic health, sleep quality had not always received adequate attention in routine diabetes care, particularly in developing countries such as Pakistan. Limited local evidence had highlighted the need to investigate this relationship among patients receiving treatment in tertiary healthcare settings. Understanding this association had been important for developing comprehensive management strategies that addressed both metabolic and behavioral determinants of diabetes outcomes [8].

Therefore, the present study had been conducted to evaluate the association between sleep quality and glycemic control among patients with type 2 diabetes mellitus attending Sheikh Zayed Hospital, Lahore  . The study had focused on assessing sleep quality and examining its relationship with HbA1c levels. The findings had aimed to provide local evidence regarding the potential contribution of sleep disturbances to poor glycemic control and to emphasize the importance of incorporating sleep assessment into routine diabetes management.

Study Design:

A descriptive cross-sectional study was conducted to determine the association between sleep quality and glycemic control among patients with type 2 diabetes mellitus.

Study Setting: The study was conducted at the Department of Medicine, Sheikh Zayed Hospital, Lahore.

Study Duration:

The study was carried out over a period of six months, from August 2025 to January 2026.

Sample Size:

A total of 110 patients diagnosed with type 2 diabetes mellitus were included in the study.

Sampling Technique:

Non-probability consecutive sampling technique was used to recruit eligible patients attending the outpatient and diabetic clinics during the study period.

Inclusion Criteria:

Patients of either gender aged 30–70 years with a confirmed diagnosis of type 2 diabetes mellitus for at least one year were included. Patients who had recent HbA1c reports available and were willing to participate in the study were enrolled after obtaining informed consent.

Exclusion Criteria:

Patients with type 1 diabetes mellitus, gestational diabetes, severe psychiatric disorders, diagnosed sleep disorders such as obstructive sleep apnea, chronic kidney disease requiring dialysis, advanced liver disease, or those taking medications that significantly affected sleep patterns were excluded. Patients with acute medical illnesses and incomplete clinical records were also excluded.

Data Collection Procedure:

After obtaining approval from the institutional ethical review committee, eligible patients were approached and informed about the objectives and procedures of the study. Written informed consent was obtained from all participants before data collection. Demographic and clinical information was collected using a structured questionnaire, which included age, gender, body mass index (BMI), duration of diabetes, family history of diabetes, smoking status, physical activity, medication use, and relevant medical history.

Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), a standardized and validated questionnaire that evaluated sleep quality over the preceding one month. The questionnaire consisted of seven components, including subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medications, and daytime dysfunction. Each component was scored from 0 to 3, producing a global PSQI score ranging from 0 to 21. A global score greater than 5 indicated poor sleep quality, whereas a score of 5 or less indicated good sleep quality.

Glycemic control was assessed by measuring glycated hemoglobin (HbA1c) levels using the most recent laboratory reports obtained within the preceding three months. Patients with HbA1c levels below 7.0% were classified as having good glycemic control, whereas those with HbA1c levels of 7.0% or higher were categorized as having poor glycemic control. Fasting blood glucose levels were also recorded when available to provide additional information regarding glycemic status.

Study Variables:

The primary independent variable was sleep quality, measured through the global PSQI score. The primary dependent variable was glycemic control, assessed through HbA1c levels. Age, gender, BMI, duration of diabetes, physical activity, smoking status, and antidiabetic treatment were considered potential confounding variables.

Statistical Analysis:

Data were entered and analyzed using Statistical Package for Social Sciences (SPSS) version 26.0. Quantitative variables, including age, BMI, duration of diabetes, PSQI scores, fasting blood glucose, and HbA1c levels, were expressed as mean ± standard deviation. Qualitative variables, including gender, sleep quality categories, and glycemic control status, were presented as frequencies and percentages. The association between sleep quality and glycemic control was evaluated using the chi-square test. Independent-sample t-test was used to compare mean PSQI and HbA1c values between relevant groups. Pearson's correlation analysis was performed to assess the relationship between global PSQI scores and HbA1c levels. A p-value of less than 0.05 was considered statistically significant.

Ethical Considerations:

The study was conducted after obtaining approval from the institutional ethical review committee of Sheikh Zayed Hospital, Lahore. Written informed consent was obtained from all participants. Confidentiality and anonymity of participants were maintained throughout the study, and collected information was used exclusively for research purposes. Participants were informed about their right to withdraw from the study at any stage without affecting their medical care.

A total of 110 patients with type 2 diabetes mellitus were included in the study. The association between sleep quality and glycemic control was assessed using the Pittsburgh Sleep Quality Index (PSQI) and glycated hemoglobin (HbA1c) levels. Sleep quality was categorized as good or poor, while glycemic control was classified according to HbA1c levels.

Table 1. Distribution of patients according to demographic characteristics, sleep quality, and glycemic control (n=110):

Table 1 demonstrated the demographic characteristics and clinical distribution of the study participants. Among the 110 patients, 35 (31.8%) belonged to the 51–60 years age group, followed by 32 (29.1%) patients aged 41–50 years. A total of 61 (55.5%) participants were male, whereas 49 (44.5%) were female. Regarding the duration of diabetes mellitus, 43 (39.1%) patients had been diagnosed with diabetes for 5–10 years, while 38 (34.5%) had a disease duration exceeding 10 years. Only 29 (26.4%) patients had diabetes for less than five years.

Assessment of sleep quality revealed that 72 (65.5%) patients experienced poor sleep quality, whereas only 38 (34.5%) reported good sleep quality. Regarding glycemic control, 68 (61.8%) patients had poor glycemic control, as indicated by HbA1c levels above 7%, while 42 (38.2%) achieved adequate glycemic control. These findings indicated that poor sleep quality and inadequate glycemic control were common among the study population.

Table 2. Association between sleep quality and glycemic control among patients with type 2 diabetes mellitus (n=110):

Table 2 demonstrated a statistically significant association between sleep quality and glycemic control among patients with type 2 diabetes mellitus. Among the 38 patients who reported good sleep quality, 25 (65.8%) had good glycemic control, whereas 13 (34.2%) had poor glycemic control. In comparison, among the 72 patients with poor sleep quality, only 17 (23.6%) achieved good glycemic control, while 55 (76.4%) had poor glycemic control. The proportion of patients with poor glycemic control was considerably higher among those experiencing poor sleep quality than among those with good sleep quality (76.4% versus 34.2%). Similarly, good glycemic control was more frequently observed among patients with good sleep quality (65.8%) compared with those experiencing poor sleep quality (23.6%). Statistical analysis using the Pearson chi-square test demonstrated a significant association between sleep quality and glycemic control (χ² = 17.51, p less than 0.001). These findings suggested that patients with poor sleep quality were more likely to have inadequate glycemic control than those with good sleep quality. The results also highlighted the potential importance of sleep assessment in the comprehensive management of type 2 diabetes mellitus. Poor sleep quality appeared to be associated with less favorable glycemic outcomes, possibly because disturbed sleep affected insulin sensitivity, glucose metabolism, hormonal regulation, and adherence to diabetes management practices. Overall, the findings demonstrated that poor sleep quality was prevalent among patients with type 2 diabetes mellitus and was significantly associated with poor glycemic control. Patients experiencing poor sleep quality had a substantially higher proportion of uncontrolled diabetes compared with those reporting good sleep quality. The study therefore emphasized the importance of assessing sleep quality as part of routine diabetes care. However, because the study followed a cross-sectional design, the findings established an association rather than a cause-and-effect relationship.

The present study evaluated the association between sleep quality and glycemic control among patients with type 2 diabetes mellitus. The findings highlighted the importance of sleep quality as a potential factor influencing metabolic regulation in diabetic patients. Sleep disturbances were frequently associated with impaired glucose metabolism, increased insulin resistance, and difficulties in maintaining optimal glycemic levels. The study findings suggested that patients with poor sleep quality experienced less favorable glycemic control than those who reported satisfactory sleep patterns [9]. These observations emphasized the importance of considering sleep health as an additional component of comprehensive diabetes management.

Sleep quality played an important role in maintaining glucose homeostasis through its effects on hormonal regulation, insulin sensitivity, and metabolic activity. Poor sleep quality was associated with increased sympathetic nervous system activity, elevated cortisol secretion, and disturbances in glucose metabolism. These physiological changes potentially contributed to increased insulin resistance and elevated blood glucose levels [10]. Furthermore, inadequate sleep duration and frequent nighttime awakenings were associated with alterations in appetite-regulating hormones, which potentially increased food intake and contributed to weight gain. These metabolic changes might have further complicated glycemic management among individuals with type 2 diabetes mellitus.

The association between poor sleep quality and elevated glycated hemoglobin (HbA1c) levels was particularly important because HbA1c reflected long-term glycemic control [11]. Patients experiencing disturbed sleep patterns potentially developed greater fluctuations in blood glucose levels due to hormonal and metabolic disturbances. Sleep fragmentation and reduced sleep efficiency were also associated with impaired glucose tolerance and decreased insulin sensitivity. These findings supported the concept that sleep disturbances represented an important behavioral and physiological factor in diabetes management rather than an isolated lifestyle concern [12].

Several previous investigations also reported significant associations between sleep disturbances and poor glycemic control among patients with type 2 diabetes mellitus. Research findings indicated that individuals with shorter sleep duration, frequent awakenings, and poor subjective sleep quality demonstrated higher HbA1c levels than those with adequate sleep patterns. These observations were consistent with the findings of the present study and further supported the relationship between sleep-related disturbances and metabolic dysfunction. Differences in study populations, assessment instruments, diabetes duration, medication adherence, and lifestyle characteristics potentially explained variations in the strength of associations reported across different investigations [13].

Psychological and behavioral factors also appeared to contribute to the relationship between sleep quality and glycemic regulation. Anxiety, depressive symptoms, diabetes-related stress, and nocturnal symptoms such as polyuria and neuropathic discomfort potentially interfered with normal sleeping patterns. Similarly, poor glycemic control itself might have contributed to sleep disturbances through nighttime urination, thirst, and other diabetes-related complications. Therefore, the relationship between sleep quality and glycemic control appeared potentially bidirectional. This consideration remained particularly relevant because the cross-sectional design of the present study did not establish a causal relationship between these variables [14].

The findings also emphasized the clinical importance of assessing sleep quality during routine diabetes follow-up visits. Healthcare professionals could have identified patients at increased risk of poor glycemic control through appropriate sleep assessments and lifestyle evaluations. Sleep hygiene education, regular sleeping schedules, physical activity, weight management, and appropriate management of sleep-related disorders could have contributed to improved metabolic health. Additionally, screening for obstructive sleep apnea and psychological disturbances might have helped identify potentially modifiable factors associated with inadequate glycemic regulation [15].

The study had certain limitations. Its cross-sectional design restricted the establishment of temporal relationships and causal associations. Furthermore, sleep quality assessment might have been influenced by subjective reporting, while other factors, including dietary habits, physical activity, medication adherence, diabetes duration, and psychological stress, could have affected glycemic control. Despite these limitations, the study provided useful evidence regarding the importance of sleep quality in patients with type 2 diabetes mellitus.

Overall, the findings supported the importance of incorporating sleep assessment into comprehensive diabetes management. Improved recognition and management of sleep disturbances might have contributed to better glycemic regulation and improved overall health outcomes among patients with type 2 diabetes mellitus.

The study concluded that poor sleep quality was associated with inadequate glycemic control among patients with type 2 diabetes mellitus. Patients experiencing disturbed sleep, frequent nighttime awakenings, and reduced sleep duration demonstrated a greater tendency toward elevated HbA1c levels compared with those who reported satisfactory sleep quality. The findings highlighted the potential role of sleep disturbances in influencing metabolic regulation and diabetes management. Poor sleep quality was identified as an important factor that may have contributed to difficulties in maintaining optimal blood glucose levels. The study emphasized the importance of assessing sleep patterns as an integral component of routine diabetes care. Healthcare professionals were encouraged to incorporate sleep quality evaluation, patient education, and appropriate sleep hygiene interventions into diabetes management strategies. Overall, the findings suggested that improving sleep quality could have supported better glycemic control and enhanced overall health outcomes among individuals with type 2 diabetes mellitus.

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