Glucose metabolism during rotational shift-work in healthcare workers
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Shift-work is associated with circadian rhythm disruption and an increased risk of obesity and type 2 diabetes. We sought to determine the effect of rotational shift-work on glucose metabolism in humans.
We studied 12 otherwise healthy nurses performing rotational shift-work using a randomised crossover study design. On each occasion, participants underwent an isotope-labelled mixed meal test during a simulated day shift and a simulated night shift, enabling simultaneous measurement of glucose flux and beta cell function using the oral minimal model. We sought to determine differences in fasting and postprandial glucose metabolism during the day shift vs the night shift.
Postprandial glycaemic excursion was higher during the night shift (381±33 vs 580±48 mmol/l per 5 h, p<0.01). The time to peak insulin and C-peptide and nadir glucagon suppression in response to meal ingestion was also delayed during the night shift. While insulin action did not differ between study days, the beta cell responsivity to glucose (59±5 vs 44±4 × 10−9 min−1; p<0.001) and disposition index were decreased during the night shift.
Impaired beta cell function during the night shift may result from normal circadian variation, the effect of rotational shift-work or a combination of both. As a consequence, higher postprandial glucose concentrations are observed during the night shift.
KeywordsAlpha cell function Beta cell function Circadian rhythm Glucose tolerance Insulin secretion Shift-work
Beta cell responsivity to glucose
Dynamic component of insulin secretion
Static component of insulin secretion
Area above basal
Endogenous glucose production
- Meal Ra
Rate of meal appearance
Rate of glucose disappearance
Insulin sensitivity index
We gratefully acknowledge the contributions of our study coordinator P. D. Giesler and our research technicians J. Laugen and G. de Foster, and thank M. M. Davis for secretarial assistance (all from the Endocrine Research Unit, Mayo Clinic).
All data generated or analysed during this study are included in this published article (and its supplementary information files).
This study was funded by awards from the Mayo Clinic General Clinical Research Center (UL1 TR000135). AV is supported by the National Institutes of Health (grant no. DK78646) and RTV is supported by a training grant (no. 5T32DK007352-37).
Duality of interest
The authors declare that there is no duality of interest associated with this manuscript.
AV designed (assisted by AM and RAR) and oversaw the study; AS ran the study; CC, CDM, MCL and RTV assisted with data acquisition, AS and AV researched the data; MCL, CDM, RTV and CC analysed and interpreted the data; AS drafted the manuscript; AM, CC, CDM, MCL, RAR and RTV reviewed and/or edited the manuscript; and AV wrote the final version of the manuscript. All authors gave final approval of the version to be published. AV is the guarantor of this work and, as such, had full access to all of the study data and takes responsibility for data integrity and the accuracy of the data analysis.
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