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NIGHT-SHIFT WORK IS ASSOCIATED WITH POORER GLYCEMIC CONTROL IN PATIENTS WITH TYPE 1 DIABETES ON INSULIN PUMP THERAPY
Abstract
Background and Aims
Night shift-work is an example of severe circadian misalignment and is associated with increased risk of developing diabetes. In patients with established diabetes, shift-work may be associated with poor glycemic control, but the data are scarce. Our aim was to evaluate if among patients with type 1 diabetes (T1D) under continuous subcutaneous insulin infusion therapy (CSII), glycemic control is worse in night shift-workers (NSW) compared to daily-workers (DW).
Methods
Retrospective analysis of T1D patients under CSII followed at our department: 28 NSW and 28 randomly selected age and sex-matched controls (DW). We collected data from CGM from the last 90 days: time in range (TIR; 70-180 mg/dL), time above range (TAR), time below range (TBR), and glycemic variability (%CV). Patients treated with CSII plus SGLT2-I were not excluded.
Results
The groups were similar with respect to duration of diabetes, age and HbA1c before starting CSII, and treatment with SGLT2-I. A significantly lower TIR (53.5% (43.0-63.0) vs 65.5% (60.3-71.8), p<0.001), higher TAR (39.0% (32.0-50.5) vs 27.5% (20.0-34.0), p=0.002), and higher %CV (42.9% (37.6-47.5) vs 39.0% (35.9-41.3), p=0.003) was observed in the NSW group (with no differences in TBR). Multivariate regression analysis showed that these results were independent of age, duration of diabetes, HbA1c before CSII, healthcare occupation and SGLT2-I treatment (p<0.05).
Conclusions
Night shift-workers had significantly poorer glycemic control compared to daily-workers. Even with CSII therapy, alterations in dietary intake and sleep with circadian misalignment may represent a challenge to optimum control in this group of patients.