http://jama.jamanetwork.com/ en-us Wed, 03 Apr 2013 00:00:00 GMT Thu, 04 Apr 2013 21:48:12 GMT Silverchair editor@jama.jamanetwork.com webmaster@jama.jamanetwork.com http://jama.jamanetwork.com/article.aspx?articleID=1674239 Wed, 03 Apr 2013 00:00:00 GMT McMullan CJ, Schernhammer ES, Rimm EB, et al. <span class="paragraphSection"><div class="boxTitle">Importance</div>Loss-of-function mutations in the melatonin receptor are associated with insulin resistance and type 2 diabetes. Additionally, in a cross-sectional analysis of persons without diabetes, lower nocturnal melatonin secretion was associated with increased insulin resistance.<div class="boxTitle">Objective</div>To study the association between melatonin secretion and the risk of developing type 2 diabetes.<div class="boxTitle">Design, Setting, and Participants</div>Case-control study nested within the Nurses' Health Study cohort. Among participants without diabetes who provided urine and blood samples at baseline in 2000, we identified 370 women who developed type 2 diabetes from 2000-2012 and matched 370 controls using risk-set sampling.<div class="boxTitle">Main Outcome Measures</div>Associations between melatonin secretion at baseline and incidence of type 2 diabetes were evaluated with multivariable conditional logistic regression controlling for demographic characteristics, lifestyle habits, measures of sleep quality, and biomarkers of inflammation and endothelial dysfunction.<div class="boxTitle">Results</div>The median urinary ratios of 6-sulfatoxymelatonin to creatinine were 28.2 ng/mg (5%-95% range, 5.5-84.2 ng/mg) among cases and 36.3 ng/mg (5%-95% range, 6.9-110.8 ng/mg) among controls. Women with lower ratios of 6-sulfatoxymelatonin to creatinine had increased risk of diabetes (multivariable odds ratio, 1.48 [95% CI, 1.11-1.98] per unit decrease in the estimated log ratio of 6-sulfatoxymelatonin to creatinine). Compared with women in the highest ratio category of 6-sulfatoxymelatonin to creatinine, those in the lowest category had a multivariable odds ratio of 2.17 (95% CI, 1.18-3.98) of developing type 2 diabetes. Women in the highest category of melatonin secretion had an estimated diabetes incidence rate of 4.27 cases/1000 person-years compared with 9.27 cases/1000 person-years in the lowest category.<div class="boxTitle">Conclusions and Relevance</div>Lower melatonin secretion was independently associated with a higher risk of developing type 2 diabetes. Further research is warranted to assess if melatonin secretion is a modifiable risk factor for diabetes within the general population.</span> 309 13 1388 1396 10.1001/jama.2013.2710 http://jama.jamanetwork.com/article.aspx?articleID=1674239