Diabetes Metab J.  2024 Jan;48(1):37-52. 10.4093/dmj.2023.0193.

Attention to Innate Circadian Rhythm and the Impact of Its Disruption on Diabetes

• Lee DY
• Jung I
• Park SY
• Yu JH
• Seo JA
• Kim KJ
• Kim NH
• Yoo HJ
• Kim SG
• Choi KM
• Baik SH
• Kim NH

• KMID: 2551260
• DOI: http://doi.org/10.4093/dmj.2023.0193

Abstract

Novel strategies are required to reduce the risk of developing diabetes and/or clinical outcomes and complications of diabetes. In this regard, the role of the circadian system may be a potential candidate for the prevention of diabetes. We reviewed evidence from animal, clinical, and epidemiological studies linking the circadian system to various aspects of the pathophysiology and clinical outcomes of diabetes. The circadian clock governs genetic, metabolic, hormonal, and behavioral signals in anticipation of cyclic 24-hour events through interactions between a “central clock” in the suprachiasmatic nucleus and “peripheral clocks” in the whole body. Currently, circadian rhythmicity in humans can be subjectively or objectively assessed by measuring melatonin and glucocorticoid levels, core body temperature, peripheral blood, oral mucosa, hair follicles, rest-activity cycles, sleep diaries, and circadian chronotypes. In this review, we summarized various circadian misalignments, such as altered light-dark, sleep-wake, rest-activity, fasting-feeding, shift work, evening chronotype, and social jetlag, as well as mutations in clock genes that could contribute to the development of diabetes and poor glycemic status in patients with diabetes. Targeting critical components of the circadian system could deliver potential candidates for the treatment and prevention of type 2 diabetes mellitus in the future.

Keyword

Body temperature; Circadian clocks; Circadian rhythm; Diabetes mellitus; Diabetes mellitus, type 2; Glucocorticoids; Jet lag syndrome

Figure

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  Fig. 1. Circadian clock system. PER, period; CRY, cryptochrome; CLOCK, circadian locomotor output cycles kaput; BMAL, brain and muscle Arnt-like protein; RORE, retinoic acid-related orphan receptor response element; REV-ERB, reverse erythroblastosis virus; ROR, retinoidrelated orphan receptor.

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  Fig. 2. Alignment (A) and misalignment (B) between central/peripheral clocks and environmental/behavioral rhythms.

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  Fig. 3. Daily oscillations of body temperature, cortisol, and melatonin.

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  Fig. 4. Cosine curve characteristics. (A) Parameters of circadian rhythmicity. Examples of delayed phase (B), advanced phase (C), low amplitude (D), and high amplitude (E) curves. MESOR, midline statistic of rhythm.

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  Fig. 5. Dominant features of glucose metabolism in the morning (A) and at night (B).

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  Fig. 6. Impact of circadian disruption on insulin resistance or diabetes. BMAL, brain and muscle Arnt-like protein; CLOCK, circadian locomotor output cycles kaput; CRY, cryptochrome.

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