Towards targeted dietary support for shift workers with type 2 diabetes (Shift‐Diabetes study): A mixed‐methods case study protocol

Background: Blood glucose is higher in people working night-shifts compared to day-workers. Changes to eating behaviour, activity, and sleep patterns in addition to circadian disruption are likely to impact glucose management in night-shift workers with Type 2 diabetes. Aim: To investigate current dietary intake and glucose variability during night work, including barriers and facilitators to dietary behavior in this context. Methods: A mixed-methods case study will be conducted. Shift workers with Type 2 diabetes working in a hospital setting will be recruited to this two-part study. Part 1: 70 participants will complete a 10-day observational study collecting data on continuous glucose, diet (self-report diary), sleep and physical activity during a period covering night work, rest days and non-night workdays. Mean glucose concentration and variability, and the mean healthy diet index score, will be compared between days of night work, non-night work and rest, after adjusting for other individual factors (sleep/physical activity/demographics). Part 2: A sample (n~13) will complete semi-structured interviews based on behavioural science frameworks to explore barriers/enablers to dietary behaviour when working night shifts. This will inform a quantitative survey to explore the generalisability of interview findings. Discussion: Findings from Part 1 and 2 will be triangulated to identify potential intervention strategies to address key barriers and enablers to healthier eating, and in turn improved glucose control, in shift workers with Type 2 diabetes. This will be facilitated through stakeholder consultation and application of behavioural science frameworks.