Chronotype Is Independently Associated With Glycemic Control in Type 2 Diabetes
- Sirimon Reutrakul, MD, CDE1⇑,
- Megan M. Hood, PHD2,
- Stephanie J. Crowley, PHD2,
- Mary K. Morgan, RD1,
- Marsha Teodori, RN1,
- Kristen L. Knutson, PHD3 and
- Eve Van Cauter, PHD4
- 1Section of Endocrinology, Department of Medicine, Rush University Medical Center, Chicago, Illinois
- 2Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
- 3Section of Pulmonary and Critical Care and Sleep, Metabolism and Health Center, Department of Medicine, The University of Chicago, Chicago, Illinois
- 4Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, and Sleep, Metabolism and Health Center Department of Medicine, The University of Chicago, Chicago, Illinois
- Corresponding author: Sirimon Reutrakul, .
M.M.H. and S.J.C. contributed equally to this study.
OBJECTIVE To examine whether chronotype and daily caloric distribution are associated with glycemic control in patients with type 2 diabetes independently of sleep disturbances.
RESEARCH DESIGN AND METHODS Patients with type 2 diabetes had a structured interview and completed questionnaires to collect information on diabetes history and habitual sleep duration, quality, and timing. Shift workers were excluded. A recently validated construct derived from mid-sleep time on weekends was used as an indicator of chronotype. One-day food recall was used to compute the temporal distribution of caloric intake. Hierarchical linear regression analyses controlling for demographic and sleep variables were computed to determine whether chronotype was associated with HbA1c values and whether this association was mediated by a higher proportion of caloric intake at dinner.
RESULTS We analyzed 194 completed questionnaires. Multiple regression analyses adjusting for age, sex, race, BMI, insulin use, depressed mood, diabetes complications, and perceived sleep debt found that chronotype was significantly associated with glycemic control (P = 0.001). This association was partially mediated by a greater percentage of total daily calories consumed at dinner.
CONCLUSIONS Later chronotype and larger dinner were associated with poorer glycemic control in patients with type 2 diabetes independently of sleep disturbances. These results suggest that chronotype may be predictive of disease outcomes and lend further support to the role of the circadian system in metabolic regulation.
- Received December 27, 2012.
- Accepted March 4, 2013.
- © 2013 by the American Diabetes Association.
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