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coronary artery diseases

Subjects with a higher score of type 1 pattern were more likely to be employed as workers, with higher frequency of overtime work beyond 21:00 PM (data not shown). Such workers may be often forced to stay awake through social cues against their preference. This may lead to disruption of the circadian system. A previous study demonstrated that forced circadian misalignment developed insulin resistance [32]. Therefore, circadian misalignment by environmental elements may contribute to worsening of glycemic control in those patients.

Patients with T2DM are known to have sleep abnormalities compared with healthy subjects [33]. In the present study, subjects with a higher score of type 1 pattern had poor sleep quality and short sleep duration. Recent studies reported both sleep quality and/or duration have negative influence on glucose and lipid metabolism in T2DM patients [911]. Sleep has major regulatory effects on metabolic function, hormone release and sympathovagal activity. Indeed, sleep deprivation is reported to be associated with low levels of circulating satiety hormone leptin, high levels of appetite stimulating hormone ghrelin [34] and high sympathetic activity [35]. These changes are expected to be deleterious for glycaemic control. Taken together, our findings suggest the synergistic deleterious effects of these unfavourable traits on glycemic control in patients with T2DM. In fact, our multivariate regression analysis suggested that type 1 pattern was associated with higher HbA1c levels even considering other lifestyle patterns. Thus, optimizing these unfavourable habits should be investigated as an intervention to improve glucose control in patients with T2DM.