Night‐shift work is associated with poorer glycaemic control in patients with type 2 diabetes

Abstract

SUMMARYThe circadian system plays a role in regulating metabolism. Night-shift work, a form of circadian misalignment, is associated with increased type 2 diabetes risk. This study aimed to determine if night-shift workers with type 2 diabetes experience poorer glycaemic control than non-shift workers. Patients with type 2 diabetes (104 unemployed, 85 day workers and 60 night-shift workers) participated. Sleep duration, sleep quality, morningness-eveningness preference, depressive symptoms and dietary intake were assessed using standardized questionnaires. Haemoglobin A1c levels were measured. Night-shift workers had significantly higher haemoglobin A1c levels compared with others, while there were no differences between day workers and unemployed participants (median 7.86% versus 7.24% versus 7.09%, respectively). Additionally, night-shift workers were younger, had a higher body mass index, and consumed more daily calories than others. Among night-shift workers, there were no significant differences in haemoglobin A1c levels between those performing rotating versus non-rotating shifts (P = 0.856), or those with clockwise versus counterclockwise shift rotation (P = 0.833). After adjusting for age, body mass index, insulin use, sleep duration, morningness-eveningness preference and percentage of daily intake from carbohydrates, night-shift work, compared with day work, was associated with significantly higher haemoglobin A1c (B = 0.059, P = 0.044), while there were no differences between unemployed participants and day workers (B = 0.016, P = 0.572). In summary, night-shift work is associated with poorer glycaemic control in patients with type 2 diabetes.

Metabolic and cardiovascular consequences of shift work: The role of circadian disruption and sleep disturbances

“…For example, Viitasalo, Kuosma, Laitinen, and Harma () found that changing from a backward‐rotating schedule to a forward‐rotating shift schedule reduced systolic blood pressure. Interestingly, it was recently reported that night shift work was associated with poorer glycaemic control compared to day work or unemployment in diabetic patients, even after controlling for variables such as sleep duration, body mass index and daily carbohydrate intake (Manodpitipong et al., ), supporting an effect of circadian misalignment independent of behavioural changes associated with night shift work in this patient population.…”

“…Various lines of evidence point towards an adverse effect of shift work on metabolic and cardiovascular risk factors, including elevated glucose, insulin and triacylglyceride levels, higher counts of white blood cells, as well as increased levels of resistin, a biomarker of atherosclerosis (Burgueno, Gemma, Gianotti, Sookoian, & Pirola, ; Manodpitipong et al., ; Sookoian et al., ; Wirth et al., ; van Drongelen, Boot, Merkus, Smid, & van der Beek, ). Indeed, a systemic review comprising 22 longitudinal studies on the association between shift work and metabolic risk factors indicated that there is a strong evidence for an effect of shift work on impaired glucose tolerance, and the risks of weight gain and being overweight (Proper et al., ).…”

Impact of circadian disruption on glucose metabolism: implications for type 2 diabetes

“…In addition to their role in predisposing people to diabetes, lifestyle factors associated with circadian disruption also associate with impaired health in individuals with diabetes. Diabetic individuals working night shifts present with higher HbA 1c levels than those not working night shifts, irrespective of rotating or non-rotating shifts and after adjusting for age, BMI, insulin use, sleep duration, morning/evening preference and percentage daily carbohydrate intake [31]. One form of behavioural misalignment that is of particular interest for individuals with diabetes is the mistiming of eating (Fig.…”

Making the night shift the right shift

“…[4][5][6] The risk that shift work poses is such that the World Health Organization International Agency for Research of Cancer has listed it as a possible carcinogen. [4][5][6] The risk that shift work poses is such that the World Health Organization International Agency for Research of Cancer has listed it as a possible carcinogen.…”

“…The health consequences of shift work has been studied and broadly linked to multiple pathologies including mental illness, cardiovascular disease and type 2 diabetes mellitus to name a few. [4][5][6] The risk that shift work poses is such that the World Health Organization International Agency for Research of Cancer has listed it as a possible carcinogen. 7 Specific to the ED, according to the American College of Emergency Physicians' Wellness Section, 'The adverse effect of constantly rotating shifts is the single most important reason given for premature attrition from the field', an important cause of burnout and premature retirement from the speciality, and a likely significant contributor to EM being the top-rated speciality for burnout.…”