Association between social jetlag and diabetes self-management in adults with type 2 diabetes: a cross-sectional study with serial mediation analysis
- 1School of Nursing, Ningxia Medical University
- 2School of Public Health, Ningxia Medical University
- 3Xiangya School of Nursing, Central South University
Abstract
Background: Diabetes self-management requires consistent daily behaviors. Social jetlag, the mismatch between workday and free-day sleep timing, may disrupt daily behavior routines. This study examined the association between social jetlag and self-management in adults with type 2 diabetes (T2D), and whether sleep quality and depressive symptoms statistically accounted for portions of this association.
Methods: This cross-sectional study recruited employed adults aged 18–60 years with T2D from the endocrinology departments of three tertiary public general hospitals in Ningxia Hui Autonomous Region, China, from January to April 2026. Social jetlag was calculated from the micro Munich Chronotype Questionnaire; sleep quality, depressive symptoms, and diabetes self-management were assessed using the Pittsburgh Sleep Quality Index, Patient Health Questionnaire-9, and Summary of Diabetes Self-Care Activities, respectively. Multivariable linear regression and serial mediation analysis with 5,000 bootstrap resamples were performed.
Results: A total of 339 participants were analyzed. Each additional h of social jetlag was associated with higher PSQI score ( B = 1.352, 95% CI 1.042 to 1.663), higher PHQ-9 score ( B = 3.772, 95% CI 3.314 to 4.229), and lower SDSCA score ( B = −6.623, 95% CI −7.566 to −5.679). The direct association remained significant after PSQI and PHQ-9 scores were included ( B = −3.830, 95% CI −5.048 to −2.611). The specific indirect association through depressive symptoms alone was −2.230 (95% bootstrap CI −3.053 to −1.469), and the serial indirect association through sleep quality and depressive symptoms was −0.314 (95% bootstrap CI −0.534 to −0.150).
Conclusion: Greater social jetlag was associated with poorer diabetes self-management. Significant indirect associations were observed through depressive symptoms alone and through the serial pathway from sleep quality to depressive symptoms. These associations do not establish temporal ordering or causal mediation because the data were cross-sectional.
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BibTeX
@article{he2026association,
title = {{Association between social jetlag and diabetes self-management in adults with type 2 diabetes: a cross-sectional study with serial mediation analysis}},
author = {Jinman He and Shuaiyou Wang and Jingyu Zhang and Shuang Li and Xiaoting Huang and Chongmei Huang and Minhui Liu},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1979499},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1979499/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Association between social jetlag and diabetes self-management in adults with type 2 diabetes: a cross-sectional study with serial mediation analysis
AU - Jinman He
AU - Shuaiyou Wang
AU - Jingyu Zhang
AU - Shuang Li
AU - Xiaoting Huang
AU - Chongmei Huang
AU - Minhui Liu
PY - 2026
DA - 2026/10/16
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1979499
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1979499/full
AB - Background: Diabetes self-management requires consistent daily behaviors. Social jetlag, the mismatch between workday and free-day sleep timing, may disrupt daily behavior routines. This study examined the association between social jetlag and self-management in adults with type 2 diabetes (T2D), and whether sleep quality and depressive symptoms statistically accounted for portions of this association. Methods: This cross-sectional study recruited employed adults aged 18–60 years with T2D from the endocrinology departments of three tertiary public general hospitals in Ningxia Hui Autonomous Region, China, from January to April 2026. Social jetlag was calculated from the micro Munich Chronotype Questionnaire; sleep quality, depressive symptoms, and diabetes self-management were assessed using the Pittsburgh Sleep Quality Index, Patient Health Questionnaire-9, and Summary of Diabetes Self-Care Activities, respectively. Multivariable linear regression and serial mediation analysis with 5,000 bootstrap resamples were performed. Results: A total of 339 participants were analyzed. Each additional h of social jetlag was associated with higher PSQI score ( B = 1.352, 95% CI 1.042 to 1.663), higher PHQ-9 score ( B = 3.772, 95% CI 3.314 to 4.229), and lower SDSCA score ( B = −6.623, 95% CI −7.566 to −5.679). The direct association remained significant after PSQI and PHQ-9 scores were included ( B = −3.830, 95% CI −5.048 to −2.611). The specific indirect association through depressive symptoms alone was −2.230 (95% bootstrap CI −3.053 to −1.469), and the serial indirect association through sleep quality and depressive symptoms was −0.314 (95% bootstrap CI −0.534 to −0.150). Conclusion: Greater social jetlag was associated with poorer diabetes self-management. Significant indirect associations were observed through depressive symptoms alone and through the serial pathway from sleep quality to depressive symptoms. These associations do not establish temporal ordering or causal mediation because the data were cross-sectional.
SN - 2296-2565
ER -