Depression and insomnia in patients with type-2 diabetes, the role of emotional regulation, physical activity and diet

Abstract

Based on previous studies, insomnia, depression, and diabetes are intercorrelated with each other. For example, insomnia was a predictor of depression (Hertenstein et al., 2018), depression was diagnosed in approximately 20% of the population with diabetes worldwide (Snoek et al., 2015), and diabetes was significantly associated with insomnia (Bhaskar et al., 2016). Nonetheless, the underlying mechanisms which denoted the co-occurrences of the three conditions have not been well-documented in the current literature. In this research study, the relation between insomnia, depression, and diabetic symptoms in patients with Type-2 diabetes would be explored. Based on the previous literature, it was hypothesized that insomnia would predict depressive and diabetic symptoms, which would be mediated by emotional regulation, physical activity, and diet. Data were obtained from 132 participants who were clinically diagnosed with type-2 diabetes. The participants were recruited at the University of Hong Kong and via online platforms, such as social media, and from organizations and groups for diabetes patients. Mediation analysis was performed to testify two models with the predictor being insomnia, the mediators being physical activity, difficulty in emotional regulation and diet, as well as the outcome measures being depression and diabetes biomarker. Only emotional regulation was found to be a significant mediator between insomnia and depression, B=.19, β =.21, BCa 95% CI [.10, .28]. An additional model, in which diabetes distress substituted the diabetes biomarker as the outcome measure, was tested. Only emotional regulation was found to be a significant mediator between insomnia and diabetes distress, B=.44, β =.17, BCa 95% CI [.21, .70]. Implications and limitations of the study were further discussed.