Later Chronotype Is Associated with Greater Depressive Symptoms in Type 2 Diabetes Patients: A Study in Two Different Ethnic Cohorts

Presentation Number: OR11-3
Date of Presentation: April 1st, 2017

Sunee Saetung*1, Megan M Hood2, Hataikarn Nimitphong3, Nantaporn Siwasaranond4, Stephanie J Crowley2 and Sirimon Reutrakul5
1Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, 2Rush University Medical Center, Chicago, IL, 3Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, 4Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand, 5Faculty of Medicine Ramahibodi Hospital, Bangkok, Thailand


The circadian system plays a role in the sleep/wake cycle and metabolism. Individuals vary in their circadian preference or chronotype, i.e. morning or evening type. Chronotype has been shown to be related to psychological functioning, i.e. more evening preference (later chronoytpe) has been associated with greater depressive symptoms in general population. In addition, sleep disturbances, more prevalent in evening types, have been associated with depression. Depression is common in type 2 diabetes (T2D) patients and related to worse outcomes. Little data exist describing whether chronotype is related to depressive symptoms in T2D, independent of sleep disturbances and other confounders. In addition, chronotype may differ by geographic locations (more morning preference near the equator). We aimed to explore the association between chronotype and depressive symptoms in T2D patients from two different geographic areas.

Cross sectional studies in T2D patients were conducted separately in Chicago (latitude 42N) (n=194) and Thailand (latitude 13N) (n=282). Demographics, diabetes history and complications were collected. Depressive symptoms were assessed by the Center for Epidemiologic Studies Depression scale (CES-D). Chronotype was assessed using the Morningness-Eveningness Questionnaire (MEQ) in the Chicago cohort, and the Composite Score of Morningness (CSM) in the Thailand cohort. Sleep quality was assessed using the Pittsburg Sleep Quality Index (PSQI). HbA1c values were retrieved from medical records.

In the Chicago cohort, mean age was 58.3±13.0 years, 69.6% were female and 28.4% were whites. Higher CES-D scores (more depressive symptoms) were associated with later chronotype (lower MEQ score, r= -0.242, p=0.001), as well as younger age (p=0.005), female sex (p=0.047), non-whites (p=0.003), insulin use (p<0.001), higher HbA1c levels (p=0.005), poorer sleep quality (p <0.001). After adjusting for age, sex, ethnicity, HbA1c, insulin use and PSQI score, later chronotype was significantly associated with higher CES-D scores (B=-0.112, p=0.045). In Thailand cohort, mean age was 55.7±11.6 years and 57.4% were female. Higher CES-D scores were associated with later chronotype (lower CSM score, r= -0.227, p<0.001), as well as younger age (p=0.019), female sex (p=0.004), and poorer sleep quality (p<0.001). After adjusting for age, sex and PSQI score, later chronoytpe was significantly associated with higher CES-D score (B= -0.114, p=0.045).

In this study of two different ethnic cohorts, later chronotype was found to be independently associated with depressive symptoms in T2D. These data support an association between circadian regulation and psychological functioning in individuals with T2D. Intervention studies targeting circadian timing should be explored to determine whether altering circadian functioning may improve depressive symptoms in T2D patients.


Disclosure: SR: , Medtronic Minimed, , Novo Nordisk, , Merck & Co., , Sanofi. Nothing to Disclose: SS, MMH, HN, NS, SJC