Observational studyDiabetologia2026
An evening chronotype is associated with the incidence and progression of diabetic retinopathy in people with type 2 diabetes mellitus: a cohort study.
Observational study in Diabetologia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Exercise and physical activity interventions in type 2 diabetes mellitus.Frontiers in endocrinology · 2026Review
- Factors associated with diabetic retinopathy: a cross-sectional study of 1477 patients across four cities in Anhui, China.Frontiers in endocrinology · 2026Article
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Authors and funding
11 authors.
Funding
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Abstract
aim/hypothesisChronotype reflects an individual's circadian rhythm, which may be associated with lifestyle habits and metabolic profiles. A few studies have shown that disruptions in circadian rhythms may contribute to the pathogenesis of diabetic retinopathy. This prospective observational study aimed to investigate the association between lifestyle habits, including chronotype, and the incidence and progression of diabetic retinopathy.
methodsThe study participants were 731 Japanese outpatients with type 2 diabetes and no apparent history of cardiovascular disease. Lifestyle habits were assessed using questionnaires, including the Morningness-Eveningness Questionnaire (MEQ), to determine chronotype at baseline and at years 2 and/or 5. The composite endpoint of this study was the incidence and progression of diabetic retinopathy. The mean values of lifestyle factors were calculated by averaging the values from baseline to the date of endpoint onset or the end of the follow-up period. A Cox proportional hazards model was used to determine the association between lifestyle habits and the composite endpoint.
resultsDuring the median follow-up period of 7.56 years (IQR 6.04-7.95), the composite endpoint was observed in 57 participants. Multivariate Cox models showed a significant negative association between the mean MEQ scores and the composite endpoint (HR 0.95; 95% CI 0.91, 0.99). In a sensitivity analysis in which the participants were divided into three groups based on mean MEQ scores, the 'more evening' chronotype group had a 2.29-fold higher risk (95% CI 1.15, 4.55) of the composite endpoint compared with the 'neither' group. Compared with the 'more morning' chronotype group, the more evening chronotype group had a 2.09-fold higher risk of the composite endpoint (95% CI 1.05, 4.13). Participants with the more evening chronotype experienced worsening glucose management over time compared with those with other chronotypes. However, a significant negative association between the mean MEQ scores and the composite endpoint was still observed after adjusting for the mean HbA CONCLUSIONS/
interpretationPeople with type 2 diabetes and an evening chronotype have worsened glucose management and are at a higher risk of incidence and/or progression of diabetic retinopathy.
trial registrationUniversity Hospital Medical Information Network Clinical Trials Registry UMIN000010932.
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