Dietary Timing, Circadian Misalignment, and Metabolic Control Among Adults With Diabetes
DOI:
https://doi.org/10.61336/jdme.0402.02Keywords:
Dietary timing, circadian rhythm, circadian misalignment, type 2 diabetes mellitus, meal timing, glycemic control, continuous glucose monitoring, chrononutritionAbstract
Dietary timing is increasingly recognized as an important component of metabolic regulation because food intake provides temporal signals to peripheral circadian clocks involved in glucose and energy metabolism. This study investigated the relationship between meal timing, circadian misalignment, and metabolic control among adults with diabetes. A cross-sectional study was conducted among 184 adults with type 2 diabetes mellitus aged 35–70 years. Dietary timing was assessed using a 14-day smartphone-assisted food diary combined with actigraphy-derived sleep-wake timing. The midpoint of daily caloric intake, eating-window duration, proportion of daily energy consumed after 18:00, and interval between the final meal and habitual sleep onset were calculated. Circadian misalignment was estimated from the difference between the midpoint of the eating period and the midpoint of the individual's habitual sleep-wake cycle. Glycemic control was assessed using HbA1c, fasting glucose, and 14-day continuous glucose monitoring. Participants with later meal timing and greater circadian misalignment demonstrated higher HbA1c, greater mean glucose concentration, lower time in range, and higher glucose variability than participants with earlier and more circadian-aligned eating patterns. A greater proportion of daily energy intake consumed during the late evening was positively associated with HbA1c and mean glucose. After adjustment for age, sex, diabetes duration, BMI, total energy intake, physical activity, sleep duration, and diabetes medication, circadian misalignment remained independently associated with poorer glycemic control. Participants in the highest misalignment category had approximately 2.5-fold greater odds of suboptimal glycemic control compared with those in the lowest category. These findings suggest that the timing of food intake and its relationship with the sleep-wake cycle may contribute to metabolic control in adults with diabetes, beyond total caloric intake alone.
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