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Diabetology International
Published in: Diabetology International 3/2017

01-08-2017 | Original Article

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

Authors: Toshiaki Ohkuma, Masanori Iwase, Hiroki Fujii, Hitoshi Ide, Shinako Kaizu, Tamaki Jodai, Yohei Kikuchi, Yasuhiro Idewaki, Akiko Sumi, Udai Nakamura, Takanari Kitazono

Published in: Diabetology International | Issue 3/2017

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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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Metadata
Title
Joint impact of modifiable lifestyle behaviors on glycemic control and insulin resistance in patients with type 2 diabetes: the Fukuoka Diabetes Registry
Authors
Toshiaki Ohkuma
Masanori Iwase
Hiroki Fujii
Hitoshi Ide
Shinako Kaizu
Tamaki Jodai
Yohei Kikuchi
Yasuhiro Idewaki
Akiko Sumi
Udai Nakamura
Takanari Kitazono
Publication date
01-08-2017
Publisher
Springer Japan
Published in
Diabetology International / Issue 3/2017
Print ISSN: 2190-1678
Electronic ISSN: 2190-1686
DOI
https://doi.org/10.1007/s13340-017-0310-6

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WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

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