Sleep habits in the pathogenesis and management of diabesity

In parallel with the rising global epidemic of obesity and diabetes, termed "diabesity" to underscore the strong relationship between these two conditions, there has been a decreasing trend in the average sleep duration in many parts of the world. Sleep is an essential component of everyday life and plays a pivotal role in regulating energy metabolism and many other physiological functions. Updated guidelines include adequate sleep as one of the key elements of lifestyle therapy in diabetes management. From epidemiological studies, there are many researchers across the globe demonstrating a U-shaped relationship between sleep duration and glycemia, as well as more adverse clinical outcomes (notably cardiovascular events and mortality) with shorter sleep in people with diabetes. Sleep deprivation results in inflammation, neurohormonal dysregulation impacting on appetite control, hedonic pathways, and reward processing and eventually facilitates obesity and diabetes. While there is a wealth of evidence supporting the mechanistic links between short sleep duration, weight gain, and dysglycemia, the reasons why long sleepers have worse metabolic health remain obscure. Not only sleep duration matters, but circadian alignment and quality of sleep are also crucial in optimizing metabolic health. Recognizing the importance of promoting sleep hygiene via non-pharmacological strategies, such as sleep extension interventions and cognitive behavioral therapy, is attracting increasing clinical attention to prevent and manage people with diabesity.