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Departments

Chrononutrition Applied to Diabetes Management: A Paradigm Shift Long Delayed

  1. Nicholas H.E. Mezitis and
  2. Vikrant Bhatnagar
  1. Ohio University Heritage College of Osteopathic Medicine, Athens, OH
  1. Corresponding author: Nicholas H.E. Mezitis, mezitis{at}ohio.edu
Diabetes Spectrum 2018 Nov; 31(4): 349-353. https://doi.org/10.2337/ds18-0014
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  • FIGURE 1.
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    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.
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    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.

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    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.
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    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.
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    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.

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Diabetes Spectrum: 31 (4)

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November 2018, 31(4)
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Chrononutrition Applied to Diabetes Management: A Paradigm Shift Long Delayed
Nicholas H.E. Mezitis, Vikrant Bhatnagar
Diabetes Spectrum Nov 2018, 31 (4) 349-353; DOI: 10.2337/ds18-0014

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Chrononutrition Applied to Diabetes Management: A Paradigm Shift Long Delayed
Nicholas H.E. Mezitis, Vikrant Bhatnagar
Diabetes Spectrum Nov 2018, 31 (4) 349-353; DOI: 10.2337/ds18-0014
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