Circadian rhythms of gut microbiota modulate nocturnal hyperglycemia in type 2 diabetes: a comprehensive review on mechanisms and chrono-targeted interventions.

Nocturnal hyperglycemia is a critical yet poorly controlled risk factor for complications in type 2 diabetes mellitus (T2DM), highlighting an unmet clinical need. The gut microbiota, a key regulator of host metabolism and circadian rhythms, has emerged as a pivotal player in this process, offering a novel therapeutic target. This article elaborates on the relationship between gut microbiota and nocturnal blood glucose control in T2DM from four key dimensions: the core gut microbiota-circadian clock, regulation by gut microbiota metabolites, the intestinal biological barrier, and neuroendocrine pathway mechanisms. Building on this, the article further explores gut microbiota-based intervention strategies: probiotic/prebiotic supplementation, time-restricted eating (TRE), and photobiomodulation therapy (PBMT). By integrating insights into the gut microbiota and circadian rhythms, this review proposes a novel therapeutic approach for patients with T2DM, offering concrete clinical guidance to improve nocturnal glycemic control.