Chrononutrition Applied to Diabetes Management: A Paradigm Shift Long Delayed

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.

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.

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.