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Abstract

Background : Work shifts could cause numerous health problems, such as sleep disorders, weight gain disorders, and unhealthy food intake consumption, leading to obesity and changes in blood glucose levels, that eventually lead to diabetes mellitus. This evidence-based case report aims to provide an evidence of association between shift work and the risk of diabetes mellitus among nurses.

Methods : We performed a literature searching from Pubmed, Embase, Cochrane, Scopus, and Google Scholar in September 2023 using keywords ‘shift work’ AND ‘diabetes’ AND ‘nurse’. We included studies that assessed the association between shift work and diabetes among nurses using observational studies, meta-analysis, and systemic review as their study design. The outcome variable was the odd ratio or the relative risk of developing diabetes. We excluded cross-over studies, clinical trials, and cross-sectional studies. In addition, quality assessment was conducted according to The Oxford Center for Evidence-Based Medicine (OCEBM).

Results : After title and abstract screening, we found seven out of twenty articles with a total of 689,273 participants. Among these articles, there were three cohort studies which found an increased relative risk (1.08 to 2.60) of diabetes among nurses who worked night and rotating shifts compared to those who did not. Another evidence from two cohort studies and one meta-analysis identified that nurses who worked in full shifts had an increased risk of diabetes (1.05 to 3.60) than those who worked non-shifts. Factors affecting the risk of diabetes were gender, unhealthy lifestyle, sleep disorders, and shift work duration (≥10 years).

Conclusions : Shift work in nurses has a significant association with the risk of diabetes mellitus. Nurses had been working shift work for more than 10 years, particularly on night shift, had a higher risk compared to those who had been working for less than 10 years without night shift. Additional factors such as obesity, smoking, lack of physical activity, unhealthy diet, and sleep disorders would increase the risk of diabetes mellitus.

References

  1. Hansen, A. B., Stayner, L., Hansen, J. & Andersen, Z. J. Night shift work and incidence of diabetes in the Danish Nurse Cohort. Occup Environ Med 73, 262–268 (2016). https://doi.org/10.1136/oemed-2015-103342
  2. Rosa, D., Terzoni, S., Dellafiore, F. & Destrebecq, A. Systematic review of shift work and nurses’ health. Occup Med (Chic Ill) 69, 237–243 (2019). https://doi.org/10.1093/occmed/kqz063
  3. Romano, M., Festini, F. & Bronner, L. [Cross-sectional study on the determinants of work stress for nurses and intention of leaving the profession]. Prof Inferm 68, 203–10 (2015).
  4. Hansen, J. & Stevens, R. G. Case-control study of shift-work and breast cancer risk in Danish nurses: Impact of shift systems. Eur J Cancer 48, 1722–1729 (2012). https://doi.org/10.1016/j.ejca.2011.07.005
  5. Ogeill, R. P., Savic, M., Ferguson, N. & Lubman, D. I. Shift-Work-Play: Understanding the positive and negative experiences of male and female shift workers to inform opportunities for intervention to improve health and wellbeing. Australian Journal of Advanced Nursing 38, (2021). https://doi.org/10.37464/2020.382.181
  6. Howick, J., Chalmers, I., Glasziou, P. & OCEBM Levels of Evidence Working Group. The Oxford 2011 Levels of Evidence. https://www.cebm.ox.ac.uk/resources/levels-of-evidence/ocebm-levels-of-evidence (2024).
  7. Zoto, E., Cenko, F., Doci, P. & Rizza, S. Effect of night shift work on risk of diabetes in healthy nurses in Albania. Acta Diabetol 56, 811–813 (2019). https://doi.org/10.1007/s00592-019-01307-8
  8. Shan, Z. et al. Rotating night shift work and adherence to unhealthy lifestyle in predicting risk of type 2 diabetes: results from two large US cohorts of female nurses. BMJ k4641 (2018). https://doi.org/10.1136/bmj.k4641
  9. Viklund, A. et al. Night and shift work patterns and incidence of type 2 diabetes and hypertension in a prospective cohort study of healthcare employees. Scand J Work Environ Health 49, 439–448 (2023). https://doi.org/10.5271/sjweh.4104
  10. Rivera, A. S., Akanbi, M., O’Dwyer, L. C. & McHugh, M. Shift work and long work hours and their association with chronic health conditions: A systematic review of systematic reviews with meta-analyses. PLoS One 15, e0231037 (2020). https://doi.org/10.1371/journal.pone.0231037
  11. Gan, Y. et al. Shift work and diabetes mellitus: a meta-analysis of observational studies. Occup Environ Med 72, 72–78 (2015). https://doi.org/10.1136/oemed-2014-102150
  12. Pan, A., Schernhammer, E. S., Sun, Q. & Hu, F. B. Rotating Night Shift Work and Risk of Type 2 Diabetes: Two Prospective Cohort Studies in Women. PLoS Med 8, e1001141 (2011). https://doi.org/10.1371/journal.pmed.1001141

Additional Files
Appendix 1.docx (66 kB)
Appendix - Literature Critical Appraisal
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