ORIGINAL RESEARCH article
Front. Public Health
Sec. Aging and Public Health
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1662118
Cross-lagged analysis of burnout and insomnia in older adult patients with diabetes mellitus complicated by hypertension: A 1-year longitudinal follow-up study
Provisionally accepted
- Sixth People's Hospital of Nantong, Nantong, China
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Objective: The aim of this study is to investigate the longitudinal bidirectional relationship between disease management burnout and insomnia symptoms in older adult patients with diabetes mellitus complicated by hypertension. Methods: A prospective cohort study was conducted, involving 326 older adult patients from the Sixth People's Hospital of Nantong City, enrolled between January 2023 and April 2025. The study utilized the Burnout in Disease Management Scale and the Insomnia Severity Index (ISI) to perform four-stage evaluations at baseline (T0), 3 months post-discharge (T1), 6 months post-discharge (T2), and 12 months post-discharge (T3). A cross-lagged structural equation model was employed to analyze the bidirectional relationship between burnout and insomnia, while accounting for confounding factors such as gender and comorbidities. Results: The influence of burnout on insomnia was significant, with burnout at T0 strongly predicting insomnia at T1 (β = 0.29, P < 0.001), and the predictive effect of burnout at T2 on insomnia at T3 peaking (β = 0.24, P < 0.001). Conversely, the impact of insomnia on burnout was also evident, with insomnia at T0 predicting burnout at T1 (β = 0.15, P < 0.05), insomnia at T1 predicting burnout at T2 (β = 0.19, P < 0.01), and insomnia at T2 predicting burnout at T3 (β = 0.21, P < 0.01). Additionally, a gender moderation effect was observed, with women exhibiting a higher degree of burnout at baseline (β = -0.11, P < 0.05), and the predictive effect of burnout at T2 on insomnia at T3 was more pronounced in women. Conclusion: A significant bidirectional and vicious cycle relationship exists between disease management burnout and insomnia symptoms in older adult patients with diabetes and hypertension. Furthermore, T2 (6 months post-discharge) emerges as a critical window for intervention. It is recommended that gender-differentiated intervention strategies be implemented and that sleep management be integrated into the standardized diagnosis and treatment pathway for this patient population.
Keywords: older, diabetes, Hypertension, burnout, insomnia, Cross-lagged study
Received: 08 Jul 2025; Accepted: 27 Aug 2025.
Copyright: © 2025 Zhang, Zhou, Qian and Yang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Qing qing Yang, Sixth People's Hospital of Nantong, Nantong, China
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