Isn’t This Just Bedtime Snacking?: The potential adverse effects of night-eating symptoms on treatment adherence and outcomes in patients with diabetes

Epidemiology/Health Services/Psychosocial Research

Isn’t This Just Bedtime Snacking?

¹Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
²Department of Medicine, University of Washington School of Medicine, Seattle, Washington

Address correspondence and reprint requests to Paul Ciechanowski, MD, Department of Psychiatry and Behavioral Sciences, Box 356560, University of Washington School of Medicine, 1959 NE Pacific, Seattle, WA 98195-6560. E-mail: pavelcie{at}u.washington.edu

Diabetes Care 2006 Aug; 29(8): 1800-1804. https://doi.org/10.2337/dc06-0315

Table 1—

Demographic characteristics by night-eating symptom status

	All patients	Night-eating symptoms	No night-eating symptoms	Test statistics (χ²)
n	714	68 (9.7)	645 (90.3)
Female sex	399 (56.0)	42 (60.9)	357 (55.4)	0.39
Caucasian race	615 (88.5)	52 (77.6)	563 (89.6)	8.61*
Married or living as married	459 (65.3)	35 (51.5)	424 (66.8)	6.34†
At least 1 year of college	621 (88.7)	58 (85.3)	563 (80.4)	0.35
Age tertiles (years)				9.24*
18–39	242 (33.9)	31 (44.9)	211 (32.7)
40–56	233 (32.6)	26 (37.7)	207 (32.1)
≥57	239 (33.5)	12 (17.4)	227 (35.2)

Table 2—

Clinical characteristics by night-eating symptom status

	All patients	Night-eating symptoms	No night-eating symptoms	Test statistics (χ²)
n	714	68 (9.7)	645 (90.3)
Type 2 diabetes	303 (42.4)	33 (47.8)	270 (41.9)	0.34
Smoking status	74 (10.6)	11 (16.4)	63 (10.0)	2.62
Use of insulin	595 (84.5)	58 (85.3)	537 (84.4)	0.04
Use of oral hypoglycemic medications	217 (30.8)	16 (23.5)	201 (31.6)	1.88
Medical comorbidity (mean number of medical conditions)	2.0 (2.0)	2.3 (2.4)	1.9 (1.9)	1.64
Diabetes complications
Retinopathy	227 (32.4)	28 (41.2)	199 (31.5)	2.63
Neuropathy	235 (33.8)	31 (45.6)	204 (32.5)	4.71*†
Nephropathy	117 (16.9)	15 (22.1)	102 (16.3)	1.44
CVD	89 (12.7)	9 (13.2)	80 (12.7)	0.02
PVD	65 (9.3)	8 (11.8)	57 (9.0)	0.54
Treatment adherence
Diet	5.0 (1.8)	4.0 (1.9)	5.1 (1.7)	4.91†‡
Exercise	2.9 (2.1)	2.3 (1.9)	3.0 (2.1)	2.61†§
Glucose monitoring	5.9 (1.8)	5.1 (2.3)	6.0 (1.7)	4.39†‡
Foot care	2.6 (2.2)	2.9 (2.3)	2.6 (2.2)	0.87
Diabetes duration (years)	16.3 ± 12.1	15.1 ± 13.4	16.4 ± 12.0	0.83
Sleep disturbance more than half days in past 2 weeks	221 (31.7)	35 (52.2)	186 (29.5)	14.5†‡
Total number diabetes symptoms (of eight)	1.7 ± 1.7	2.6 ± 2.1	1.6 ± 1.6	4.64‖

Data are n (%) or means ± SD.
*
↵* P < 0.05;
†
↵† significant after Bonferroni adjustment for multiple comparisons within category;
‡
↵‡ P < 0.001;
§
↵§ P < 0.01;
‖
↵‖ F(2,711). CVD, cardiovascular disease; PVD, peripheral vascular disease.

Table 3—

Psychosocial characteristics by night-eating symptom status

	All patients	Night-eating symptoms	No night-eating symptoms	Test statistics (χ²)
n	714	68 (9.7)	645 (90.3)
Major depression	66 (9.5)	13 (19.7)	53 (8.4)	8.83*
Emotional eating triggers
Anger	138 (19.3)	21 (34.8)	114 (17.7)	11.7†‡
Sadness	286 (40.1)	38 (55.1)	248 (38.4)	7.17*‡
Loneliness	287 (40.2)	44 (63.8)	243 (37.7)	17.66†‡
Worry	253 (35.4)	41 (59.4)	212 (32.9)	19.21†‡
Being upset	217 (30.4)	31 (44.9)	186 (28.8)	7.63†‡
Childhood Trauma Questionnaire
Family was a source of strength	440 (64.0)	33 (50.8)	407 (65.3)	5.41§
Frightened of being hurt	136 (19.8)	26 (38.2)	110 (17.7)	16.23†‡
Someone in family hated individual	88 (12.9)	19 (27.9)	69 (11.2)	15.25†‡
Sexual abuse	74 (10.9)	15 (22.4)	59 (9.6)	10.19*‡
Sexual coercion	23 (3.4)	7 (10.3)	16 (2.6)	11.16†‡
Physical abuse	83 (12.1)	16 (23.5)	67 (10.8)	9.27*‡
Parental neglect	46 (6.7)	11 (16.4)	35 (5.6)	11.27†‡
Nonsecure attachment style	382 (53.5)	46 (66.7)	336 (52.1)	5.32‡§

Data are n (%). For Childhood Trauma Questionnaire items, 25% of cells had counts of <5, so Fisher’s exact test was used.
*
↵* P < 0.01;
†
↵† P < 0.001;
‡
↵‡ significant after Bonferroni adjustment for multiple comparisons within category;
§
↵§ P < 0.05.

Table 4—

Clinical characteristics and outcomes by night-eating symptom status

Clinical characteristic	All patients	Night-eating symptoms	No night-eating symptoms	Odds ratio (95% CI)
n	714	68 (9.7)	645 (90.3)
A1C >7%	429 (64.0)	53 (77.9)	376 (62.5)	2.2 (1.1–4.1)
BMI >30 kg/m²	229 (32.1)	33 (47.8)	196 (30.4)	2.6 (1.5–4.5)
Complications (two or more)	194 (27.2)	28 (40.6)	166 (25.7)	2.6 (1.5–4.5)

Odds ratio represents the odds of having the clinical characteristic in patients with night-eating symptoms compared with those without night-eating symptoms. Logistic multivariate models control for age, sex, race, and major depression status. A 95% CI >1.0 represents a significance level of P < 0.05.