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. 2018 Nov;31(4):349-353.
doi: 10.2337/ds18-0014.

Chrononutrition Applied to Diabetes Management: A Paradigm Shift Long Delayed

Nicholas H E Mezitis  1 , Vikrant Bhatnagar  1
Affiliations

Chrononutrition Applied to Diabetes Management: A Paradigm Shift Long Delayed

Nicholas H E Mezitis et al. Diabetes Spectr. 2018 Nov.
No abstract available

PubMed Disclaimer

Figures

FIGURE 1.
FIGURE 1.
The relationship of environmental (light and dark) cues with the central pacemaker and its effects on the periphery. SCN, suprachiasmatic nuclei.
FIGURE 2.
FIGURE 2.
Proposed paradigm shift in diabetes management redirecting focus to the rest period exemplified by the “stress-sleep” pillar. Patients and providers appreciate this concept by reviewing glycemic profiles as 4:00 p.m. to 4:00 p.m. depictions, as opposed to midnight-to-midnight. This graphic modification emphasizes the defining role of dinner in determining the next day’s fasting (morning) glucose level.
FIGURE 3.
FIGURE 3.
Novel presentation of glucose data from a patient with type 1 diabetes. The CGM data reflect on the liver (gut/pacemaker) activity (indicated with a red bar). The shaded blue area represents the 25th–75th percentile of glucose results. Panel A is a standard modal day CGM depiction from midnight to midnight that does not highlight the relationship of dinner to morning fasting blood glucose. Panel B showcases a modified CGM report depicting data from 4:00 p.m. to 4:00 p.m. and clearly demonstrating the effects of dinner on morning glycemia. Panel C illustrates the glycemic benefit of lifestyle modification when redistributing dinner calories in favor of breakfast and lunch.
FIGURE 4.
FIGURE 4.
Glucose data from a patient with type 2 diabetes. In Panel A, the patient is on insulin with conventional meal plan emphasizing (late) dinner. Panel B shows that implementing the new feeding paradigm (4:00 a.m. to 4:00 p.m.) permitted the patient to maintain euglycemia while off insulin. The red bars mark the circadian rhythm for liver (gut/pacemaker) activity.
FIGURE 5.
FIGURE 5.
Glucose data from a second patient with type 2 diabetes. In Panel A, the patient is on insulin and oral agents with a conventional meal plan emphasizing (late) dinner. Panel B shows that implementing the new paradigm (feeding from 4:00 a.m. to 4:00 p.m.) permitted the patient to maintain euglycemia with diet alone. The red bars mark the circadian rhythm for liver (gut/pacemaker) activity.
See this image and copyright information in PMC

References

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