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‘Social jetlag’ can make type 1 diabetes management more difficult

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November 28, 2018

Glycemic control in adults with type 1 diabetes is negatively affected by small recurrent circadian rhythm disruption, or social jetlag, according to findings published in the Journal of Diabetes.

“The sleep debt accumulated on workdays is later recovered on free days, leading to repeated sleep and circadian misalignment during the week,” Cornelia Bala, MD, PhD, LLD, lecturer at the department of diabetes and nutrition diseases at Iuliu Hatieganu University of Medicine and Pharmacy and the Clinical Diabetes Center at the Emergency County Hospital in Cluj-Napoca, Romania, and colleagues wrote. “Although it is well-known that the circadian rhythm is involved in the regulation of metabolic processes, only recently has circadian misalignment been regarded as a potential contributor to glucose dysregulation outside the setting of shift work.”

After consecutively enrolling 115 adults (44.3% women; mean age, 37.3 years) with type 1 diabetes duration longer than 6 months at the Clinical Center of Diabetes, Nutrition and Metabolic Diseases at the Emergency County Clinical Hospital in Cluj-Napoca, Romania, Bala and colleagues performed an observational cross-sectional study. Using participant interviews conducted between May 2017 and January 2018, the researchers determined bedtime, sleep-onset latency and wake-up times of the participants during the previous month on both weekdays and weekends.

Researchers divided participants according to amount of social jetlag — the difference in midsleep time during weekends and weekdays: 53 participants had social jetlag of at least 1 hour and the remaining 62 less than 1 hour. The researchers noted that those with social jetlag of at least 1 hour were younger (mean age, 31.5 years vs. 42.3 years; P < .001), had shorter mean diabetes duration (14.1 years vs. 19.8 years; P = .005) and slept longer on average on the weekends (8.8 hours vs. 7.9 hours, P = .001).

In the group with social jetlag of at least 1 hour, HbA1c levels were higher compared with those from the group with social jetlag of less than 1 hour (8.6% vs. 8%; P = .046), even when adjusting for variables such as age, diabetes duration, insulin dose and BMI (P = .029). Social jetlag of at least 1 hour explained 18.6% of the increase in HbA1c before adjustment (P = .046) and 23.1% when adjustments were made for variables, such as age, diabetes duration, insulin dose and BMI (P = .021), according to researchers. HbA1c was also significantly predicted by social jetlag of at least 1 hour, with 22.7% of the increase explained by the parameter. Poor sleep quality was also a predictor (23.5%), but only before adjustment for age, sex, diabetes duration, total insulin dose, insulin regimen and BMI.

“We showed that in patients with [type 1 diabetes], a small recurrent circadian rhythm disruption is associated with poor glycemic control, and this association is independent of age, sex, diabetes duration, total insulin dose per kilogram per day, insulin regimen, BMI, and other sleep and circadian rhythm measurements (sleep duration, sleep quality, chronotype). We also showed that [social jetlag] acts independently of sleep quality in exerting a deleterious effect on glycemic control in these patients,” the researchers wrote. “Further studies investigating potential pathogenic mechanisms involved and studies testing the effectiveness of interventions aiming to correct sleep behavior are required to confirm these associations.” – by Phil Neuffer

Disclosures: Bala reports she has received fees from AstraZeneca, Bayer, Boehringer Ingelheim, Medtronic, Sanofi and the Coca-Cola Foundation. Please see the study for all other authors’ relevant financial disclosures.