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

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

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)296-305
Number of pages10
JournalDiabetology International
Volume8
Issue number3
DOIs
Publication statusPublished - Aug 1 2017

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Type 2 Diabetes Mellitus
Registries
Insulin Resistance
Life Style
Joints
Hemoglobins
Adiponectin
Dietary Fiber
C-Reactive Protein
Sleep
Homeostasis
Obesity
Eating
Smoking
Confidence Intervals
Insulin

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

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

In: Diabetology International, Vol. 8, No. 3, 01.08.2017, p. 296-305.

Research output: Contribution to journalArticle

Ohkuma, Toshiaki ; Iwase, Masanori ; Fujii, Hiroki ; Ide, Hitoshi ; Kaizu, Shinako ; Jodai, Tamaki ; Kikuchi, Yohei ; Idewaki, Yasuhiro ; Sumi, Akiko ; Nakamura, Udai ; Kitazono, Takanari. / Joint impact of modifiable lifestyle behaviors on glycemic control and insulin resistance in patients with type 2 diabetes : the Fukuoka Diabetes Registry. In: Diabetology International. 2017 ; Vol. 8, No. 3. pp. 296-305.
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T1 - Joint impact of modifiable lifestyle behaviors on glycemic control and insulin resistance in patients with type 2 diabetes

T2 - the Fukuoka Diabetes Registry

AU - Ohkuma, Toshiaki

AU - Iwase, Masanori

AU - Fujii, Hiroki

AU - Ide, Hitoshi

AU - Kaizu, Shinako

AU - Jodai, Tamaki

AU - Kikuchi, Yohei

AU - Idewaki, Yasuhiro

AU - Sumi, Akiko

AU - Nakamura, Udai

AU - Kitazono, Takanari

PY - 2017/8/1

Y1 - 2017/8/1

N2 - 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.

AB - 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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