Association of chronotype with glycemic control, sleep patterns and meal timings among adults with type 2 diabetes mellitus

Fariya Khaled; P. Ashlesha; Sujatha Stephen; K. Mounika

doi:10.18203/2394-6040.ijcmph20264080

Authors

Fariya Khaled Department of Food and Nutrition, Veeranari Chakali Ilamma Women’s University, Koti, Hyderabad, Telangana, India
P. Ashlesha Department of Food and Nutrition, Veeranari Chakali Ilamma Women’s University, Koti, Hyderabad, Telangana, India
Sujatha Stephen Yashoda Hospitals, Malakpet, Hyderabad, Telangana, India
K. Mounika Yashoda Hospitals, Malakpet, Hyderabad, Telangana, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20264080

Keywords:

Chronotype, Glycemic control, HbA1c meal timings, Sleep patterns, Type 2 diabetes mellitus

Abstract

Background: Type 2 Diabetes Mellitus (T2DM) is a major public health concern, with lifestyle factors such as chronotype potentially influencing glycemic control and daily behavioral patterns. The present study aimed to assess the association of chronotype with glycemic control, sleep patterns, and meal timings among adults with type 2 diabetes mellitus.

Methods: A hospital-based cross-sectional study was conducted among 100 adults with T2DM attending Yashoda Hospital, Malakpet, Hyderabad. Data were collected using a structured questionnaire, clinical records, and the Reduced Morningness-Eveningness Questionnaire (rMEQ). Glycemic control was assessed using fasting blood glucose (FBG), postprandial blood glucose (PPBG), and glycated haemoglobin (HbA1c). One-way analysis of variance (ANOVA) and Chi-square tests were used for statistical analysis, with p<0.05 considered statistically significant.

Results: The intermediate chronotype was the most prevalent (49%), followed by the evening chronotype (28%) and morning chronotype (23%). The mean HbA1c was highest among participants with the evening chronotype (8.257±1.641%) and lowest among those with the morning chronotype (7.617±0.780%); however, the difference was not statistically significant (p=0.242). Similarly, no significant associations were observed between chronotype and FBG (p=0.962) or PPBG (p=0.725). Significant associations were observed between chronotype and wake-up time (p<0.001), bedtime (p<0.001), lunch timing (p=0.013), and dinner timing (p=0.004). No significant associations were observed with breakfast timing (p=0.089), sleep duration (p=0.640), sleep quality (p=0.109), or BMI (p=0.229).

Conclusions: Chronotype was significantly associated with certain daily behavioral patterns, particularly wake-up time, bedtime, lunch timing, and dinner timing, but was not significantly associated with glycemic control in the study population.

References

International Diabetes Federation. IDF Diabetes Atlas 11th edition 2025. Available at: https://diabetesatlas.org/resources/idf-diabetes-atlas-2025/⁠. Accessed 11 August 2026.

American Diabetes Association Professional Practice Committee. 2. Diagnosis and classification of diabetes: Standards of Care in Diabetes 2024. Diabetes Care. 2024;47(Suppl 1):S20-S42.

Roenneberg T, Pilz LK, Zerbini G, Winnebeck EC. Chronotype and social jetlag: a (self-) critical review. Biology (Basel). 2019;8(3):54.

Reutrakul S, Hood MM, Crowley SJ, Morgan MK, Teodori M, Knutson KL, et al. Chronotype is independently associated with glycemic control in type 2 diabetes. Diabetes Care. 2013;36(9):2523-9.

Osonoi Y, Mita T, Osonoi T, Saito M, Tamasawa A, Nakayama S, et al. Morningness-eveningness questionnaire score correlates with glycated hemoglobin in Japanese patients with type 2 diabetes mellitus. Diabetes Res Clin Pract. 2014;105(1):44-50.

Mokhlesi B, Temple KA, Tjaden AH, Edelstein SL, Utzschneider KM, Nadeau KJ, et al. Association of self-reported sleep and circadian measures with glycemia in adults with prediabetes or recently diagnosed untreated type 2 diabetes. Diabetes Care. 2019;42(7):1326-32.

Henry CJ, Kaur B, Quek RYC. Chrononutrition in the prevention and treatment of obesity and metabolic syndrome. Nutr Diabetes. 2020;10:35.

Nimitphong H, Siwasaranond N, Saetung S, Ongphiphadhanakul B, Reutrakul S. The relationship between breakfast time, chronotype, and body mass index in individuals with type 2 diabetes. Chronobiol Int. 2018;35(7):943-51.

Qian J, Scheer FAJL. Circadian system and glucose metabolism: implications for physiology and disease. Trends Endocrinol Metab. 2016;27(5):282-93.

Reutrakul S, Van Cauter E. Interactions between sleep, circadian function, and glucose metabolism: implications for risk and severity of diabetes. Ann N Y Acad Sci. 2014;1311(1):151-73.

Chaput JP, McNeil J, Després JP, Bouchard C, Tremblay A. Short sleep duration as a risk factor for the development of the metabolic syndrome in adults. Prev Med. 2013;57(6):872-7.

Adan A, Almirall H. Horne and Östberg morningness-eveningness questionnaire: a reduced scale. Personality and Individual Differences. 1991;12(3):241-53.

WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157-163.

Malone SK, Patterson F, Lu Y, Lozano A, Hanlon A. Ethnic differences in sleep duration and morning-evening type in a population sample. Chronobiol Int. 2016;33(1):10-21.