Physical behaviours and chronotype in people with Type 2 diabetes

Introduction Previous investigations have suggested that evening chronotypes may be more susceptible to obesity-related metabolic alterations. However, whether device-measured physical behaviours differ by chronotype in those with 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 Ltd, Kimbolton, UK) on their non-dominant wrist for 7 days to quantify different physical behaviours (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 minutes 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 behaviours 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, BMI=30.9±5.1kg/m²). 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 minutes/day, 95% CI 8.6, 48.3), and lower MVPA levels (-9.7mins/day, -14.9, -4.6) compared to morning chronotypes. The intensity of the most active continuous 2-60 minutes of the day, average acceleration and intensity gradient were lower in evening chronotypes. The timing of physical behaviours also differed across chronotypes, with evening chronotypes displaying a later sleep onset and consistently later physical activity time.

Conclusions People with T2DM lead a lifestyle characterised by sedentary behaviours and insufficient MVPA. This may be exacerbated in those with a preference for ‘eveningness’ (i.e., go to bed late and get up late).