Physical behaviors and chronotype in people with type 2 diabetes

Jul 18, 2020BMJ open diabetes research & care

Daily activity patterns and natural sleep-wake preferences in people with type 2 diabetes

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Abstract

Evening exhibited 28.7 minutes more sedentary time per day compared to morning chronotypes.

Evening chronotypes had 9.7 minutes less moderate-to-vigorous physical activity (MVPA) daily than morning chronotypes.
The intensity of the most active periods throughout the day was lower in evening chronotypes.
Evening chronotypes displayed a later onset of sleep and engaged in physical activity at later times.
The study involved 635 participants, averaging 63.8 years of age, and included varying proportions of morning, intermediate, and evening chronotypes.

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INTRODUCTION: Previous investigations have suggested that evening may be more susceptible to obesity-related metabolic alterations. However, whether device-measured physical behaviors differ by chronotype in those with type 2 diabetes (T2DM) remains unknown.

RESEARCH DESIGN AND METHODS: This analysis reports data from the ongoing Chronotype of Patients with Type 2 Diabetes and Effect on Glycaemic Control (CODEC) observational study. Eligible participants were recruited from both primary and secondary care settings in the Midlands area, UK. Participants were asked to wear an accelerometer (GENEActiv, ActivInsights, Kimbolton, UK) on their non-dominant wrist for 7 days to quantify different physical behaviors (sleep, sedentary, light, moderate-to-vigorous physical activity (MVPA), intensity gradient, average acceleration and the acceleration above which the most active continuous 2, 10, 30 and 60 min are accumulated). Chronotype preference (morning, intermediate or evening) was assessed using the Morningness-Eveningness Questionnaire. Multiple linear regression analyses assessed whether chronotype preference was associated with physical behaviors and their timing. Evening chronotypes were considered as the reference group.

RESULTS: 635 participants were included (age=63.8±8.4 years, 34.6% female, body mass index=30.9±5.1 kg/m). 25% (n=159) of the cohort were morning chronotypes, 52% (n=330) intermediate and 23% (n=146) evening chronotypes. Evening chronotypes had higher sedentary time (28.7 min/day, 95% CI 8.6 to 48.3) and lower MVPA levels (-9.7 min/day, -14.9 to -4.6) compared to morning chronotypes. The intensity of the most active continuous 2-60 min of the day, average acceleration and intensity gradient were lower in evening chronotypes. The timing of physical behaviors also differed across chronotypes, with evening chronotypes displaying a later sleep onset and consistently later physical activity time. 2

CONCLUSIONS: People with T2DM lead a lifestyle characterized by sedentary behaviors and insufficient MVPA. This may be exacerbated in those with a preference for 'eveningness' (ie, go to bed late and get up late).

Key numbers

28.7 min/day

Increase in Sedentary Time

Sedentary time for evening compared to morning .

9.7 min/day

Decrease in MVPA

MVPA for evening compared to morning .

25% morning, 52% intermediate, 23% evening

Distribution

Percentage of participants by preference.

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Physical behaviors and chronotype in people with type 2 diabetes

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