Among 8,974 Chinese adults, irregular sleep patterns were associated with an increased risk of developing type 2 diabetes.
Individuals with moderately irregular sleep patterns had a 22% higher risk of developing type 2 diabetes compared to those with irregular sleep.
Those with regular sleep patterns also had a 22% higher risk of type 2 diabetes compared to individuals with irregular sleep.
A non-linear relationship was found, indicating the highest risk occurred at mid-range levels of sleep regularity.
Meeting recommended sleep duration did not reduce the elevated risk linked to irregular sleep patterns.
Individuals with regular sleep but inadequate duration showed a lower, non-significant risk of developing type 2 diabetes.
Simplified
BACKGROUND: Sleep regularity, defined as the consistency of sleep-wake timing across days, is increasingly recognized as an important dimension of sleep health. While inadequate sleep duration is a known risk factor for type 2 diabetes (T2D), the independent contribution of irregular sleep remains poorly understood. Evidence is particularly limited in Asian populations using objective sleep measures.
OBJECTIVES: To evaluate the association between accelerometer-derived sleep regularity and incident T2D, and to examine whether meeting recommended sleep duration mitigates the risk associated with irregular sleep patterns.
METHODS: We analyzed data from 8,974 insured Chinese adults aged 40-79 years using wearable-linked medical insurance records between August 2020 and June 2023. Raw accelerometry data were collected over 7 consecutive days and processed to compute the (SRI). Individuals were classified into regular (SRI > 87.3), moderately irregular (71.6-87.3), and irregular (< 71.6) categories. Sleep duration was categorized as adequate or inadequate based on age-specific recommendations. Incident T2D was identified from hospital electronic health records and prescription registries during a median 3.0-year follow-up. Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) for T2D across SRI categories and in joint exposure models.
RESULTS: Compared to individuals with irregular sleep, those with moderately irregular (HR 1.22; 95% CI: 1.08-1.39) and regular sleep (HR 1.22; 95% CI: 1.06-1.40) patterns had significantly higher risk of developing T2D. A non-linear association was observed, with the highest risk at mid-range SRI levels. Meeting sleep duration recommendations did not mitigate the elevated risk associated with irregular sleep. Notably, individuals with regular sleep but insufficient duration had a lower, though non-significant, risk of T2D (HR 0.77; 95% CI: 0.56-1.07).
CONCLUSIONS: In this database-based Chinese cohort, sleep regularity showed a non-linear association with incident T2D risk, independent of sleep duration. Public health efforts to promote consistent sleep timing may offer additional benefits for diabetes prevention beyond sleep duration alone.
Key numbers
1.00
Increase in risk
Reference group: Regular sleep with adequate duration.
8,974
Final analytical sample size
Participants with valid data on sleep and diabetes outcomes.
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Declarations. Ethics approval and consent to participate: This study was approved by the Ethics Committee of Shanghai Sixth People’s Hospital (Approval No: 2025-KY-135(K)). Due to the retrospective nature of the study, which used anonymized medical insurance data and routinely collected accelerometer data without involving direct contact with participants, informed consent was waived by the Ethics Committee. All procedures performed in this study complied with institutional guidelines and the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.
