The effect of telemedicine and cognitive behavioural therapy on sleep and health outcomes in type 2 diabetes patients: a randomized controlled trial

Cognitive behavioural therapy intervention targeting both type 2 diabetes and insomnia delivered by a therapist who have received full training for cognitive behavioural therapy intervention delivery. The intervention contains 10 online sessions delivered weekly in groups of 10 to 12. The approximate duration of each session is 60 minutes. Participants receive online reading materials before each session. The online reading materials are designed specifically for this study and participants are recommended (not compulsory) to read the materials prior to the session. Contents included in the intervention are knowledges and skills on sleep restriction, stimulus control, sleep hygiene, cognitive restructure, relaxation training, self-monitoring of blood glucose, diet, exercise and substance intake management. The skills participants are prescribed in the cognitive behavioural therapy include: (1) keep a sleep diary for self-monitoring of sleep quality; (2) develop and keep a regulated sleep schedule; (3) identify and avoid the behaviours that are not beneficial for sleep and blood glucose control; (4) identify and change the understandings and thoughts that are not beneficial for sleep and blood glucose control; (5) set up bedroom environment that promote sleep; (6) physical and mental relaxation skills; (7) skills for self-monitoring of blood glucose; (8) develop a balanced diet; (9) develop a healthy exercise plan; (10) communication skills to share own difficulties and feelings to others. Practice of these skills are part of the weekly sessions leaded by the therapist. Patients are also required to practice these skills after the weekly sessions and share their progress in the following sessions. Strategies used to monitor and ensure the adherence to the intervention include: (1) Participants are required to keep their sleep diary and record their blood glucose at least five days per week and report to the therapist every week. (2) Participants are required to complete a homework containing 3-5 multiple choice questions about the session contents after each session and report back to the therapist before the beginning of next session. (3) There will be a short telephone chat between each participant and the therapist every week (approximately 15 minutes). Therapist will give comments on sleep diaries, blood glucose records and homework from the previous session, and answer any questions raised during the intervention. (4) An attendance checklist will be used to record the participance of the weekly sessions. Participants completing all sessions will receive a certificate of completion at the end of the project. Polysomnography devices: Participants will be informed that they can use polysomnography devices provided by the hospital to monitor their sleep during the participant recruiting process. The PSG device used is the "Alice NightOne" home sleep testing device provided by PHILIPS RESPIRONICS (Primary DI Number: 00606959039797). Participants will receive full instructions on using the devices from the staff in the hospital. Participants will be required to use the devices for only one night at three timepoints in during the research (baseline, 3 months and 6 months), then return the device to the hospital.