Association between social jetlag and diabetes self-management in adults with type 2 diabetes: a cross-sectional study with serial mediation analysis.

Greater social jetlag was associated with lower diabetes self-management scores in adults with type 2 diabetes.

• Each additional hour of social jetlag was associated with a lower SDSCA score (B = -6.623, 95% CI -7.566 to -5.679).
• Analysis used multivariable linear regression in 339 employed adults aged 18-60 years with T2D.
• Social jetlag was calculated from the micro Munich Chronotype Questionnaire; self-management was measured with the Summary of Diabetes Self-Care Activities.

Greater social jetlag was associated with poorer sleep quality.

• Each additional hour of social jetlag was associated with a higher PSQI score (B = 1.352, 95% CI 1.042 to 1.663).
• Higher PSQI scores indicate poorer sleep quality.

Greater social jetlag was associated with more depressive symptoms.

• Each additional hour of social jetlag was associated with a higher PHQ-9 score (B = 3.772, 95% CI 3.314 to 4.229).

The direct association between social jetlag and self-management remained significant after accounting for sleep quality and depressive symptoms.

• Direct association after including PSQI and PHQ-9 scores: B = -3.830, 95% CI -5.048 to -2.611.
• This is smaller in magnitude than the total association (B = -6.623), suggesting part of the association is statistically accounted for by the mediators.

Depressive symptoms alone showed a significant indirect association between social jetlag and self-management.

• Specific indirect association through depressive symptoms alone was -2.230 (95% bootstrap CI -3.053 to -1.469).
• Estimated using serial mediation analysis with 5,000 bootstrap resamples.

A serial pathway from sleep quality to depressive symptoms showed a significant indirect association between social jetlag and self-management.

• Serial indirect association through PSQI then PHQ-9 was -0.314 (95% bootstrap CI -0.534 to -0.150).
• The abstract highlights significant indirect associations through depressive symptoms alone and through the serial pathway.

The cross-sectional design prevents establishing temporal ordering or causal mediation.

• Data were collected cross-sectionally from three tertiary public general hospitals in Ningxia Hui Autonomous Region, China.
• The authors state the associations do not establish temporal ordering or causal mediation.