Insomnia as an Independent Behavioral Correlate of Estimated Type 2 Diabetes Risk: Evidence from Three Validated Risk Assessment Scales

José Luis Ribes Valles, Pedro Juan Tárraga López, Ángel Arturo López González, Irene Coll Campayo, Carla Busquets-Cortés, and José Ignacio Ramírez-Manent

Abstract

Background: Sleep disturbances, particularly insomnia, are increasingly recognized as behavioral determinants of type 2 diabetes (T2DM). However, their contribution to validated diabetes risk scores beyond traditional sociodemographic and lifestyle factors remains insufficiently explored.

Objective: To examine the association between insomnia severity, sociodemographic variables, lifestyle habits, and estimated T2DM risk using three validated non-invasive risk assessment scales.

Methods: A cross-sectional study was conducted among 84,898 Spanish workers aged 18–69 years undergoing occupational health evaluations (2021–2024). Sociodemographic and behavioral data were collected through standardized questionnaires, including adherence to the Mediterranean diet (MEDAS-14), physical activity (IPAQ-SF), and smoking status. Insomnia was assessed using the Insomnia Severity Index (ISI). Diabetes risk was estimated using three validated non-invasive risk-assessment tools: the Finnish Diabetes Risk Score, the QDScore/QDiabetes, and the Trinidad Risk Assessment Questionnaire for Type 2 Diabetes Mellitus. As these instruments were developed and validated in different populations, comparisons of absolute risk categories across scales should be interpreted with caution. Multivariable logistic regression models adjusted for age, sex, social class, smoking, diet, and physical activity were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).

Results: Severe insomnia was associated with approximately 2.1–2.6-fold higher odds of high estimated diabetes risk across all three scales in the pooled analyses, with significant trends across categories of insomnia severity (all P for trend <0.001). This association persisted across sex and activity strata. Adding ISI modestly improved model discrimination (ΔAUC ≈ +0.015; P≤0.003) and reclassification (continuous net reclassification improvement [NRI], 6.5%–8.1%).

Conclusions: Insomnia severity was independently associated with higher estimated risk of T2DM beyond measured sociodemographic and lifestyle determinants. Incorporating sleep health—via brief tools such as the ISI—into diabetes risk assessment could enhance early prevention strategies in clinical and occupational settings.

Rambam Maimonides Med J 2026;17(3):e0019