For last week’s practice question, we quizzed participants on diabetes and sleep health. 69% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it by clicking here.
SW is a 52-year-old living with type 2 diabetes. Over the past year, A1C increased from 7.1% to 8.2%, and blood pressure during their visit was 146/88 mmHg. They report increased fatigue, daytime sleepiness, difficulty concentrating, and waking up several times during the night. SW works rotating night shifts at a manufacturing plant.
Which of the following responses would best align with the 2026 ADA Standards of Care?.
- A. Reassure SW that the sleep complaints are a normal consequence of shift work and focus the visit on intensifying glucose-lowering and antihypertensive medications to address the rising A1C and elevated blood pressure.
- B. Recommend SW take an over-the-counter melatonin supplement nightly, intensify glucose-lowering medications, and schedule a follow-up in 3 months to reassess A1C and blood pressure.
- C. Screen for sleep health and disorders and refer to a sleep medicine specialist or other qualified specialist, as indicated.
- D. Discuss with SW the impacts of night shift work, consider changing to a day shift to improve diabetes self-management, A1c and reduce blood pressure.
Getting to the Best Answer
Answer A is incorrect. 10.96% chose this answer, “Reassure SW that the sleep complaints are a normal consequence of shift work and focus the visit on intensifying glucose-lowering and antihypertensive medications to address the rising A1C and elevated blood pressure.” This answer is incorrect. While intensifying diabetes medications and addressing hypertension are important components of care, dismissing the sleep complaints as simply a normal consequence of shift work does not align with the 2026 ADA Standards of Care. Keep reading for additional recommendations.
Answer B is incorrect. 4.39% of you chose this answer, “Recommend SW take an over-the-counter melatonin supplement nightly, intensify glucose-lowering medications, and schedule a follow-up in 3 months to reassess A1C and blood pressure.” his answer is incorrect. Although sleep is recognized as a key component of diabetes management, the 2026 ADA Standards of Care do not recommend over-the-counter melatonin as a primary intervention for sleep complaints in people with diabetes. SW’s symptoms with excessive daytime sleepiness and frequent nocturnal awakenings warrant evaluation for obstructive sleep apnea (OSA) and other sleep disorders. Untreated OSA contributes to hyperglycemia, insulin resistance, and hypertension through sympathetic nervous system activation.
Answer C is correct. About 69.30% of respondents chose this: “Screen for sleep health and disorders and refer to a sleep medicine specialist or other qualified specialist, as indicated.” Answer C is correct. You chose the best answer. Great Job! This response directly aligns with the 2026 ADA Standards of Care, Section 5 recommendation to screen for sleep health and refer to sleep medicine specialists and/or qualified behavioral health professionals when indicated. SW’s symptoms are consistent with possible OSA, which has a prevalence of approximately 55% in type 2 diabetes, and the combination of worsening A1C and elevated blood pressure may be partly driven by an untreated sleep disorder. Additionally, individuals with diabetes who perform shift work increase their risk for circadian rhythm disorders, which are associated with elevated A1C, neuropathy, and decreased psychological well-being.
Finally, Answer D is incorrect. 15.35% chose this answer, “Discuss with SW the impacts of night shift work, consider changing to a day shift to improve diabetes self-management, A1c and reduce blood pressure.” Answer D is incorrect. While the 2026 ADA Standards of Care acknowledge that shift work increases the risk for circadian rhythm disorders and is associated with elevated A1C, the Standards do not recommend that individuals quit shift work as a prerequisite for diabetes management. Advising a patient to quit their job is neither practical nor evidence-based and does not address the immediate need for sleep disorder screening and management
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!
Want to Learn More about this Question?
Enroll in our Solving Glucose Mysteries For Type 2
to Watch On-Demand Webinar
Solve common glucose mysteries and optimize time-in-range for people with type 2 diabetes.
Why are glucose levels elevated in the morning? When should insulin be started? What is the next step to get A1c to target? During this course Coach Beverly addresses each of these glucose mysteries and more, using a person-centered approach. She describes a stepwise approach to evaluate glucose patterns and correct common issues encountered by people living with type 2 diabetes.
Course Topics:
- Describe common glucose mysteries encountered by people with type 2 diabetes
- Discuss assessment strategies to determine a realistic dosing strategy using national guidelines
- Use a stepwise approach to evaluate factors affecting glucose patterns
- State interventions to increase time-in-range and improve quality of life
Course Objectives
Upon completion of this activity, participants will be able to:
- Apply current standards of care and evidence-based guidelines to develop and adjust individualized treatment plans in complex diabetes cases.
- Calculate and fine-tune insulin dosing using advanced pattern management strategies in patients with fluctuating needs, including those using pumps or those hospitalized.
