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Joint impact of modifiable lifestyle behaviors on glycemic control and insulin resistance in patients with type 2 diabetes: the Fukuoka Diabetes Registry

Abstract

Aims

Little is known about the combined effects of unhealthy lifestyle behaviors on glycemia. The objective of this study was to examine the association between combined modifiable lifestyle and glycemic control, as well as markers of insulin resistance and secretion.

Patients and methods

In total, 4,870 patients with type 2 diabetes were sorted by lifestyle scores. Scores were determined by summing the number of unhealthy lifestyle factors that showed a significant association with hemoglobin A1c (HbA1c) (current smoking, decreased dietary fiber intake, eating quickly, inadequate sleep duration, and obesity). The associations between lifestyle score and hemoglobin A1c (HbA1c), homeostasis model assessment of insulin resistance (HOMA2-IR), and β-cell function (HOMA2-%B) were cross-sectionally analyzed.

Results

HbA1c increased progressively with increases in lifestyle score (p for trend <0.001). Mean HbA1c was 0.48% (95% confidence intervals 0.34–0.63) higher in patients with scores of four to five than in those with zero scores. HOMA2-IR and high-sensitivity C-reactive protein also revealed a similar tendency, but adiponectin showed an inverse association. However, these graded tendencies were not observed for HOMA2-%B. Additionally, lower HOMA2-%B levels enhanced the effects of lifestyle score on glycemia. Increases in HbA1c per point in the lifestyle score in patients with the lowest and highest quartiles of HOMA2-%B were 0.25% (0.18–0.32) and 0.10% (0.06–0.15), respectively (p for interaction <0.001).

Conclusions

Accumulation of unhealthy lifestyle factors was dose-dependently associated with poor glycemic control, which may be modified by insulin secretory capacity.

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Abbreviations

BDHQ:

Brief-type Self-administered Diet History Questionnaire

BMI:

Body mass index

CI:

Confidence interval

HS-CRP:

High-sensitivity C-reactive protein

HbA1c :

Hemoglobin A1c

HOMA2-%B:

Homeostasis model assessment of β-cell function

HOMA2-IR:

Homeostasis model assessment of insulin resistance

MET·h/w:

Metabolic equivalent hours per week

VIF:

Variance inflation factor

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Acknowledgements

The authors thank the doctors from Kyushu University (Yutaka Kiyohara, Yasufumi Doi, Toshiharu Ninomiya, Yoichiro Hirakawa, Shigenobu Kanba, Dongchon Kang, Shuzo Kumagai, Chisa Matsumoto, Yuji Komorita), from Fukuoka Red Cross Hospital (Nobutaka Tsutsu, Nobuhiro Sasaki), from St. Mary’s Hospital (Kiyohide Nunoi, Yuichi Sato, Yuji Uchizono, Ayumi Yamauchi, Kaori Itoh, Chie Kouno), from Steel Memorial Yawata Hospital (Sakae Nohara, Hirofumi Imoto, Kazushi Amano, Chie Kitaoka), from Kyushu Central Hospital (Daisuke Gotoh, Toshitaka Himeno, Masae Toyonaga), from Fukuoka Higashi Medical Center (Noriyasu Shinohara, Ayako Tsutsumi), from Hakujyuji Hospital (Masahiro Nakano, Mina Matsuo, Shoko Morimoto, Tomoko Hyodo), from Clinic Minami Masae (Masae Minami), from Wada Miya Naika Clinic (Miya Wada), from Yokomizo Naika Clinic (Yoshifumi Yokomizo), from Kikuchi Naika Clinic (Masanori Kikuchi), from Suzuki Naika Clinic (Riku Nomiyama), from Nakamura Naika Clinic (Shin Nakamura), from Oshima Eye Hospital (Kenji Tashiro), from Yoshinari Naika Clinic (Mototaka Yoshinari), from Fukutsu Naika Clinic (Kojiro Ichikawa), and from Hisayama Research Institute For Lifestyle Diseases (Teruo Omae). We also thank the clinical research coordinators Chiho Ohba, Yumi Ono (Hisayama Research Institute For Lifestyle Diseases), and Kayoko Sekioka (Kyushu University), and the administration officials Tomoko Matake (Hisayama Research Institute For Lifestyle Diseases) and Junko Ishimatsu (Kyushu University). This work was supported in part by the Japan Society for the Promotion of Science KAKENHI (Grant Number 23249037, 23659353, to M.I., and 16K00861 to H.F.), and a grant from the Japan Diabetes Foundation (to T.O.) and the Japan Heart Foundation and Astellas/Pfizer Grant for Research on Atherosclerosis Update (to T.O.).

Author contributions

TO, HF and MI were responsible for the study concept and design. TO and MI performed the analyses and TJ, HF, HI, SK, YK, YI, AS, UN, and TK helped interpret the data and contributed to the discussion. TO and MI drafted the manuscript. All authors participated in critically revising the manuscript and approved the final version. MI is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Correspondence to Masanori Iwase.

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Conflict of interest

Honoraria for lectures: Takanari Kitazono (Daiichi-Sankyo Company, Limited, Bayer Yakuhin, Limited). Total clinical research grants: Takanari Kitazono (Mitsubishi Tanabe Pharma Corporation, Daiichi-Sankyo Company, Limited, Astellas Pharma Incorporated, Takeda Pharmaceutical Company, Limited, Eisai Company, Limited, Chugai Pharmaceutical Company, Limited, Merck Sharp and Dohme, Sanofi K.K.).

Human rights statement and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent was obtained from all patients for being included in the study.

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Ohkuma, T., Iwase, M., Fujii, H. et al. Joint impact of modifiable lifestyle behaviors on glycemic control and insulin resistance in patients with type 2 diabetes: the Fukuoka Diabetes Registry. Diabetol Int 8, 296–305 (2017). https://doi.org/10.1007/s13340-017-0310-6

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  • DOI: https://doi.org/10.1007/s13340-017-0310-6

Keywords

  • Diabetes mellitus
  • Epidemiology
  • Insulin resistance
  • Lifestyle modification