Sleep and Glycemic Control in Shift Workers with Type 2 Diabetes
Presentation Number: MON 636
Date of Presentation: April 3rd, 2017
Areesa Manodpitipong*1, Sunee Saetung2, Hataikarn Nimitphong3, Nantaporn Siwasaranond4, Thanawat Wongphan5, Chotima Sornsiriwong6, Pranee Luckanajantachote7, Prasitchai Mangjit8 and Reutrakul Reutrakul9
1Faculty of medicine RamathibodHospital, ฺBangkok, Thailand, 2Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, 3Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, 4Faculty of Medicine Ramahibodi Hospital, Bangkok, Thailand, 5Ministry of Public Health, Bangkok, Thailand, 6Rayong Provincial Hospital, Rayong, Thailand, 7Samutsakorn Provincial Hospital, Samutsakorn, Thailand, 8Kaengkhoi Hospital, Saraburi, Thailand, 9Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
Background: Circadian system has been known to play a role in glucose metabolism. Circadian disruption occurs when there is a misalignment of the endogenous circadian rhythm (central circadian clock, sleep/wake cycle) and the external environment (light/dark, meal time), leading to multiple hormonal and metabolic disturbances. Disruption in biological rhythms was observed in a majority of night shift workers and associated with increased risk of diabetes. In addition, shift workers often experienced shorter sleep duration and were reported to consume unhealthy diet, both of which adversely affected glucose metabolism. Whether type 2 diabetes (T2D) patients performing shift work had poorer glycemic control than non-shift workers, independently of dietary intake and sleep disturbances, was largely unknown.
Material and methods: A cross sectional study was conducted in 260 T2D patients; 62 night shift workers, 94 day workers and 104 unemployed participants. Sleep duration, sleep quality and daily calories intake were obtained by standardized questionnaires. Most recent HbA1c values were obtained from medical records.
Results: Mean age of all participants was 56.4±11.2 years. Night shift workers had significant higher HbA1c compared to day workers and unemployed participants (8.23 ± 1.77% vs 7.58 ± 1.39% vs 7.54 ± 1.45%, P = 0.01). Night shift workers were younger, had shorter diabetes duration and higher BMI than day workers and unemployed participants (29.6 ± 6.1 kg/m2 vs. 28.9 ± 5.1 kg/m2 vs. 27.5 ± 4.2 kg/m2, P = 0.028). There were no significant differences among groups regarding sleep quality but night shift workers had significantly shorter sleep duration (night shift workers 5.1 ±1.7 h vs day workers 5.7 ±3.1 h vs unemployed 5.3 ± 1.5 h, P = 0.023). Additionally, night shift workers consumed significantly more daily calories than day workers and unemployed group (1436 ± 577 vs 1098 ± 410 vs 1099 ± 485, P < 0.001) but percentages of macronutrient intake were similar among groups. After adjusting for age, sex, BMI, diabetes duration, insulin use, sleep duration and percentage of daily fat intake, night shift work was associated with significantly higher HbA1C levels when cmpared to day work (B = 0.063, P = 0.030). There was no significant difference in glycemic control between unemployed participants and day workers (B = 0.013, P = 0.639).
Conclusion: T2D patients performing night shift work had significantly poorer glycemic control than day workers, independently of sleep duration and dietary intake. These results supported the adverse effects of circadian disruption on glucose metabolism. Interventions, possibly targeting the reduction of circadian misalignment, are needed to improve glycemic control in this patient group.
Disclosure: RR: Clinical Researcher, Merck & Co., Speaker, Novo Nordisk, Speaker, Medtronic Minimed, Speaker, Sanofi. Nothing to Disclose: AM, SS, HN, NS, TW, CS, PL, PM