Associations Between Screen Exposure, Multidimensional Sleep Indicators, and Type 2 Diabetes: A Cross-sectional Study Using US National Survey Data.

Abstract

BACKGROUND: As type 2 diabetes mellitus (T2DM) becomes an increasingly urgent global health concern, interest has grown in how screen-based behaviors contribute to its risk. Excessive screen exposure is often associated with sedentary lifestyles, poor sleep quality, and circadian disruption-all potential contributors to T2DM. Yet, how screen time interacts with specific sleep characteristics in shaping diabetes risk remains underexplored. OBJECTIVE: This study investigates the relationship between screen exposure and T2DM risk, with particular focus on sleep duration and diagnosed sleep disorders as potential effect modifiers. We also explored variation by age, sex, and racial/ethnic groups. METHODS: We analyzed data from 23 023 US adults in the 2007 to 2016 National Health and Nutrition Examination Survey. Screen exposure was dichotomized using age-specific thresholds (≥2 vs <2 hours/day for ages 3 to 18; ≥3 vs <3 hours/day for adults). Type 2 diabetes mellitus was defined by self-reported physician diagnosis. Sleep duration and diagnosed sleep disorders were examined as modifiers. Missing data were handled using multiple imputation by chained equations, and survey-weighted multinomial logistic regression was applied. RESULTS: High screen exposure was associated with increased odds of T2DM in fully adjusted models (odds ratio [OR] = 3.47, 95% confidence interval [CI]: 2.74, 4.36). Sleep duration was not independently associated with T2DM, whereas sleep disorders were linked to approximately twofold higher odds (OR = 2.21, 95% CI: 1.17, 4.18). The screen-T2DM association was stronger among females than males, with variation observed across sleep and racial/ethnic subgroups. CONCLUSION: Excessive screen time is linked to elevated T2DM risk, particularly among females and individuals with sleep disorders. Longitudinal research is needed to assess causality and inform targeted interventions.

AI evidence extraction

Main findings

In survey-weighted fully adjusted models, high screen exposure was associated with increased odds of type 2 diabetes (OR 3.47, 95% CI 2.74–4.36). Sleep duration was not independently associated with type 2 diabetes, while diagnosed sleep disorders were associated with higher odds (OR 2.21, 95% CI 1.17–4.18). The screen–type 2 diabetes association was stronger among females than males, with variation across sleep and racial/ethnic subgroups.

Outcomes measured

• Type 2 diabetes mellitus (self-reported physician diagnosis)
• Sleep duration
• Diagnosed sleep disorders

Limitations

• Cross-sectional design (causality not established)
• Type 2 diabetes defined by self-reported physician diagnosis
• Screen exposure dichotomized using thresholds (may reduce exposure detail)
• Potential residual confounding not fully assessable from abstract

{
    "study_type": "cross_sectional",
    "exposure": {
        "band": null,
        "source": "screen exposure",
        "frequency_mhz": null,
        "sar_wkg": null,
        "duration": "Dichotomized screen time: ≥2 vs <2 hours/day (ages 3–18); ≥3 vs <3 hours/day (adults)"
    },
    "population": "US adults (NHANES 2007–2016)",
    "sample_size": 23023,
    "outcomes": [
        "Type 2 diabetes mellitus (self-reported physician diagnosis)",
        "Sleep duration",
        "Diagnosed sleep disorders"
    ],
    "main_findings": "In survey-weighted fully adjusted models, high screen exposure was associated with increased odds of type 2 diabetes (OR 3.47, 95% CI 2.74–4.36). Sleep duration was not independently associated with type 2 diabetes, while diagnosed sleep disorders were associated with higher odds (OR 2.21, 95% CI 1.17–4.18). The screen–type 2 diabetes association was stronger among females than males, with variation across sleep and racial/ethnic subgroups.",
    "effect_direction": "harm",
    "limitations": [
        "Cross-sectional design (causality not established)",
        "Type 2 diabetes defined by self-reported physician diagnosis",
        "Screen exposure dichotomized using thresholds (may reduce exposure detail)",
        "Potential residual confounding not fully assessable from abstract"
    ],
    "evidence_strength": "low",
    "confidence": 0.7800000000000000266453525910037569701671600341796875,
    "peer_reviewed_likely": "yes",
    "keywords": [
        "screen time",
        "screen exposure",
        "sleep duration",
        "sleep disorders",
        "type 2 diabetes",
        "NHANES",
        "multinomial logistic regression",
        "multiple imputation",
        "US national survey"
    ],
    "suggested_hubs": []
}

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