Chronotype is independently associated with glycemic control in type 2 diabetes

Diabetes Care. 2013 Sep;36(9):2523-9. doi: 10.2337/dc12-2697. Epub 2013 May 1.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Glucose / metabolism*
  • Circadian Rhythm / physiology
  • Diabetes Mellitus, Type 2 / blood*
  • Energy Intake / physiology
  • Female
  • Glycated Hemoglobin / metabolism
  • Humans
  • Male
  • Middle Aged
  • Sleep / physiology
  • Surveys and Questionnaires
  • Young Adult


  • Blood Glucose
  • Glycated Hemoglobin A