Night shift workers living with type 2 diabetes (T2D) face challenges in maintaining a healthy diet and managing their condition.
The findings by King's College London, as part of a series of studies published in Diabetic Medicine, underscore the need for tailored support to help this group improve their health and well-being.
While previous research has compared dietary intake and blood sugars between shift workers against non-shift workers, this is the first to examine how shift patterns impact food choices and blood glucose within the same individual.
Those involved in the study were healthcare workers - from both NHS and private sectors - including nurses, midwives and people working in care homes. Participants were monitored over 10 days, covering night shifts, day shifts and rest days. They wore glucose monitors and activity monitors, and were asked to record a diet diary.
The research paints a clear picture of the difficulties night shift workers with T2D encounter in maintaining a healthy diet. The interviews revealed that these workers often struggle with limited access to nutritious food options during night shifts. Vending machines and 24-hour cafés typically offer high-sugar, high-fat foods, leaving few healthy alternatives. Additionally, the lack of time and proper facilities to prepare or store meals means many rely on convenience foods, which are often less nutritious. Interestingly, the research also found greater variability in glucose at night, which may reflect the poorer quality nutrition available during a night shift.
"What struck me is that these are people who work in healthcare, yet they don't have access a healthy nighttime food environment or tailored dietary advice. These people might have been advised by their doctors to eat healthily to manage their diabetes, but if food choices are limited during the night, they might be unable to do so."
Dr Rachel Gibson, King's College London
Another key and unexpected finding of the study was that shift workers' days vary in length. Shift workers are awake for variable lengths of time depending on the shift that they work - for example participants may be awake for around 22 hours when a night shift is worked, this changes to 17 hours when a day shift is worked and 16 hours on a day off. As most participants worked an irregular schedule the day length is like a concertina - constantly contracting and expanding. We do not know the implications of this finding on health and blood glucose management and are looking to investigate this further.
Dr Gibson was inspired to pursue this area of research after, while training as a dietitian, she saw firsthand how much of an impact occupation has on nutrition. She said: "Many clinicians don't ask questions about work, despite this study revealing just how much of an impact someone's nature of work can have on their behaviour and dietary choices.
"From an employer perspective, I believe we should take nutrition as seriously as other areas, like DSE, already embedded into occupational health assessments."
Co-author Dr Nicola Guess, who began the research at King's before joining the University of Oxford, added: "Some of the ideas for this research came from people living with T2D who told us that managing their diabetes while doing shifts was challenging, and they wanted more research in this area. We are grateful for Diabetes UK for providing funding, and we hope the insights from this research will help us develop more personalised support for shift workers with type 2 diabetes, and will lead to hospital policies which help employees to maintain health habits".
