Association of Chronotype, Sleep Quality, Body Mass Index, and Glycemic Control in Type 2 Diabetes: A Cross-Sectional Study
Abstract
Background: Circadian misalignment via chronotype and sleep disturbances may harm metabolic control in type 2 diabetes (T2D), but evidence is unclear. Objectives. This study investigated the association of chronotype, sleep quality, BMI, and HbA1c in patients with T2D, with sex-specific analysis. Methods: This cross-sectional study included a systematic random sample of 1,000 patients with T2D, of whom 39% were male. Participants' chronotypes and sleep patterns were assessed using the reduced Morningness-Eveningness Questionnaire and the shortened Pittsburgh Sleep Quality Index (shortPSQI). Clinical data collected included BMI, HbA1c, and comorbidities. Chi-square, t-test, and regression analysis were conducted. Results: Participants' mean age: 60.0±11.3 years; BMI: 30.5±5.5 kg/m²; HbA1c: 7.3±1.7%. Evening chronotypes had higher BMI (p<0.001) and HbA1c >7%. In both sexes, chronotype correlated with BMI and HbA1c (p<0.05). Poor sleep (shortPSQI>4) was prevalent in 68% of participants with T2D. Being overweight (OR=1.686) and having uncontrolled HbA1c (≥7%) (OR=1.747) were independently associated with higher odds of poor sleep quality. Evening chronotypes were independently associated with both poorer glycemic control (OR=2.174) and sleep quality (OR=2.213). Female sex was independently associated with lower odds of elevated HbA1c (OR=0.605), whereas village residence (OR=1.685), insulin-based therapy (OR=4.655), combined therapy (OR=12.973), longer diabetes duration (≥10 years) (OR=2.739), poor sleep quality (OR=1.418), and non-morning chronotypes (moderately morning: OR=2.564, intermediate: OR=2.033, and moderately evening: OR=3.727) were associated with elevated HbA1c higher odds. Conclusions: In adults with T2D, evening chronotypes tend to have higher BMIs and HbA1c levels, especially in males, and poor sleep quality is particularly linked to these variables in females. Given the cross-sectional study design, these findings warrant further investigation in longitudinal studies.
Keywords:
Body Mass Index, Circadian Rhythm, Chronotype, Type 2 Diabetes, Sleep Quality
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References
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Chaaya, R., Cattan, R., Lahoud, C., Tornquist, D., Barreto Schuch, F., Merhi, G., ... & Fekih-Romdhane, F. (2025). Validation of the Arabic version of the reduced Horne-Östberg morningness-eveningness questionnaire (rMEQ). Chronobiology International, 42(8), 1060-1071. https://doi.org/10.1080/07420528.2025.2525465
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Famodu, O. A., Barr, M. L., Holásková, I., Zhou, W., Morrell, J. S., Colby, S. E., & Olfert, M. D. (2018). Shortening of the Pittsburgh Sleep Quality Index survey using factor analysis. Sleep Disorders, 2018(1), 9643937. https://doi.org/10.1155/2018/9643937
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Farooque, R., Herekar, F., Iftikhar, S., & Patel, M. J. (2020). The frequency of poor sleep quality in patients with diabetes mellitus and its association with glycemic control. Cureus, 12(11). https://doi.org/10.7759/cureus.11608
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Humood, E., Ahmad, M., Khawaja, N., Khader, Y. and Ajlouni, K. (2026) “Association of Chronotype, Sleep Quality, Body Mass Index, and Glycemic Control in Type 2 Diabetes: A Cross-Sectional Study”, International Journal of Advancement in Life Sciences Research, 9(4), pp. 145-160. doi: https://doi.org/10.31632/ijalsr.2026.v09i04.010.
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