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Data fusion levels

The incident of type 2 diabetes mellitus (T2DM) is related to numerous lifestyle problems. Furthermore, the incidence of cardiovascular disease (CVD) and diabetes related microvasuclar events is strongly related with lifestyle factors in patients with T2DM [1,2]. Lifestyle modifications such as a reduction in energy intake and an increase in physical activity can reduce the onset of T2DM [3] in non-T2DM population and the development of CVD in T2DM patients [4,5]. On the other hand, the reported effects of these interventions on the risks were very modest. Furthermore, a recent clinical trial that focused on the control of energy intake and increased physical activity in obese patients with T2DM showed no effect for lifestyle intervention on CVD [6]. In this regard, much attention should be paid to lifestyles other than diet and physical activity as lifestyle problems that could affect future CVD.

Recent studies have demonstrated the importance of sleep duration and/or quality as lifestyle factors, based on findings confirming the pathological roles of these factors in the onset of T2DM [7] and CVD [8]. Other studies reported that both sleep duration and/or quality can affect cardiovascular risk factors in T2DM patients [911].

Morningness-eveningness reflects the timing of the sleep-wake pattern and different aspects of sleep duration and/or quality, which are quite variable among individuals. In individuals of the evening type, social rhythms do not synchronize with the circadian clock. Previous studies demonstrated that evening type individuals tend to have unhealthy eating habits, behavioral health problems, and sleep complains more than morning type subjects [12,13]. More recently, we found inadequate glycemic control in evening type patients with T2DM [14] [15]. These findings suggest that evening type individuals potentially have impaired metabolism by abnormal circadian rhythm.

The prevalence of depression is reportedly higher in T2DM patients than non-T2DM [16]. Given that T2DM-related depression is related to poor glycemic control [17] and micro- and macro-vascular complications [18], partly due to increased counter-regulatory hormones [19], the depression status may be an important risk factor for defective glycemic control and T2DM-related complications in patients with T2DM.