Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Diabetology International Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

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

References

  1. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87:4–14.

    Article  CAS  PubMed  Google Scholar 

  2. Standards of medical care in diabetes-2015. Diabetes Care. 2015;38: S1-87.

  3. Chen L, Pei JH, Kuang J, Chen HM, Chen Z, Li ZW, et al. Effect of lifestyle intervention in patients with type 2 diabetes: a meta-analysis. Metabolism. 2015;64:338–47.

    Article  CAS  PubMed  Google Scholar 

  4. Ohkuma T, Fujii H, Iwase M, Kikuchi Y, Ogata S, Idewaki Y, et al. Impact of eating rate on obesity and cardiovascular risk factors according to glucose tolerance status: the Fukuoka Diabetes Registry and the Hisayama Study. Diabetologia. 2013;56:70–7.

    Article  CAS  PubMed  Google Scholar 

  5. Ohkuma T, Fujii H, Iwase M, Kikuchi Y, Ogata S, Idewaki Y, et al. Impact of sleep duration on obesity and the glycemic level in patients with type 2 diabetes: the Fukuoka Diabetes Registry. Diabetes Care. 2013;36:611–7.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Fujii H, Iwase M, Ohkuma T, Ogata-Kaizu S, Ide H, Kikuchi Y, et al. Impact of dietary fiber intake on glycemic control, cardiovascular risk factors and chronic kidney disease in Japanese patients with type 2 diabetes mellitus: the Fukuoka Diabetes Registry. Nutr J. 2013;12:159.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kaizu S, Kishimoto H, Iwase M, Fujii H, Ohkuma T, Ide H, et al. Impact of leisure-time physical activity on glycemic control and cardiovascular risk factors in Japanese patients with type 2 diabetes mellitus: the Fukuoka Diabetes Registry. PLoS One. 2014;9:e98768.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Ohkuma T, Iwase M, Fujii H, Kaizu S, Ide H, Jodai T, et al. Dose- and time-dependent association of smoking and its cessation with glycemic control and insulin resistance in male patients with type 2 diabetes mellitus: the Fukuoka Diabetes Registry. PLoS One. 2015;10:e0122023.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kobayashi S, Honda S, Murakami K, Sasaki S, Okubo H, Hirota N, et al. Both comprehensive and brief self-administered diet history questionnaires satisfactorily rank nutrient intakes in Japanese adults. J Epidemiol. 2012;22:151–9.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Sasaki S, Katagiri A, Tsuji T, Shimoda T, Amano K. Self-reported rate of eating correlates with body mass index in 18-y-old Japanese women. Int J Obes Relat Metab Disord. 2003;27:1405–10.

    Article  CAS  PubMed  Google Scholar 

  11. Maruyama K, Sato S, Ohira T, Maeda K, Noda H, Kubota Y, et al. The joint impact on being overweight of self reported behaviours of eating quickly and eating until full: cross sectional survey. BMJ. 2008;337:a2002.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc. 2000;32:S498–504.

    Article  CAS  PubMed  Google Scholar 

  13. Ministry of Health, Labour and Welfare. Standards for physical activities for health promotion 2013. http://www.mhlw.go.jp/stf/houdou/2r9852000002xple-att/2r9852000002xpqt.pdf (in Japanese). Last accessed 1 Dec 2016.

  14. New criteria for ‘obesity disease’ in Japan. Circ J. 2002;66:987–92.

    Article  Google Scholar 

  15. Schrieks IC, Heil AL, Hendriks HF, Mukamal KJ, Beulens JW. The effect of alcohol consumption on insulin sensitivity and glycemic status: a systematic review and meta-analysis of intervention studies. Diabetes Care. 2015;38:723–32.

    CAS  PubMed  Google Scholar 

  16. Idewaki Y, Iwase M, Fujii H, Ohkuma T, Ide H, Kaizu S, et al. Genetically determined aldehyde dehydrogenase 2 activity with diabetic complications in relation to alcohol consumption in Japanese patients with type 2 diabetes mellitus: the Fukuoka Diabetes Registry. PLoS One. 2015;10:e0143288.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Radloff LS. The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401.

    Article  Google Scholar 

  18. HOMA Calculator. http://www.dtu.ox.ac.uk/homacalculator/index.php. Accessed 20 June 2012.

  19. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393–403.

    Article  CAS  PubMed  Google Scholar 

  20. Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among patients with impaired glucose tolerance. N Engl J Med. 2001;344:1343–50.

    Article  CAS  PubMed  Google Scholar 

  21. Mozaffarian D, Kamineni A, Carnethon M, Djousse L, Mukamal KJ, Siscovick D. Lifestyle risk factors and new-onset diabetes mellitus in older adults: the cardiovascular health study. Arch Intern Med. 2009;169:798–807.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kahn SE, Hull RL, Utzschneider KM. Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature. 2006;444:840–6.

    Article  CAS  PubMed  Google Scholar 

  23. Facchini FS, Hollenbeck CB, Jeppesen J, Chen YD, Reaven GM. Insulin resistance and cigarette smoking. Lancet. 1992;339:1128–30.

    Article  CAS  PubMed  Google Scholar 

  24. Jiang J, Qiu H, Zhao G, Zhou Y, Zhang Z, Zhang H, et al. Dietary fiber intake is associated with HbA1c level among prevalent patients with type 2 diabetes in Pudong New Area of Shanghai, China. PLoS One. 2012;7:e46552.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Otsuka R, Tamakoshi K, Yatsuya H, Wada K, Matsushita K, OuYang P, et al. Eating fast leads to insulin resistance: findings in middle-aged Japanese men and women. Prev Med. 2008;46:154–9.

    Article  PubMed  Google Scholar 

  26. Chaput JP, Despres JP, Bouchard C, Tremblay A. Association of sleep duration with type 2 diabetes and impaired glucose tolerance. Diabetologia. 2007;50:2298–304.

    Article  PubMed  Google Scholar 

  27. Ohkuma T, Fujii H, Iwase M, Ogata-Kaizu S, Ide H, Kikuchi Y, et al. U-shaped association of sleep duration with metabolic syndrome and insulin resistance in patients with type 2 diabetes: the Fukuoka Diabetes Registry. Metabolism. 2014;63:484–91.

    Article  CAS  PubMed  Google Scholar 

  28. Fukushima M, Suzuki H, Seino Y. Insulin secretion capacity in the development from normal glucose tolerance to type 2 diabetes. Diabetes Res Clin Pract. 2004;66(Suppl 1):S37–43.

    Article  CAS  PubMed  Google Scholar 

  29. Lauderdale DS, Knutson KL, Yan LL, Liu K, Rathouz PJ. Self-reported and measured sleep duration: how similar are they? Epidemiology. 2008;19:838–45.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Lockley SW, Skene DJ, Arendt J. Comparison between subjective and actigraphic measurement of sleep and sleep rhythms. J Sleep Res. 1999;8:175–83.

    Article  CAS  PubMed  Google Scholar 

  31. Petty AJ, Melanson KJ, Greene GW. Self-reported eating rate aligns with laboratory measured eating rate but not with free-living meals. Appetite. 2013;63:36–41.

    Article  PubMed  Google Scholar 

  32. Oshida H, Muneyuki T, Suwa K, Nakajima K. Potential relationship between self-assessed eating speed and recalled duration of eating meals in apparently healthy adults. Br J Med Med Res. 2013;4:257–62.

    Article  Google Scholar 

  33. Reis JP, Loria CM, Sorlie PD, Park Y, Hollenbeck A, Schatzkin A. Lifestyle factors and risk for new-onset diabetes: a population-based cohort study. Ann Intern Med. 2011;155:292–9.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Fretts AM, Howard BV, McKnight B, Duncan GE, Beresford SA, Mete M, et al. Life’s Simple 7 and incidence of diabetes among American Indians: the Strong Heart Family Study. Diabetes Care. 2014;37:2240–5.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Ricardo AC, Anderson CA, Yang W, Zhang X, Fischer MJ, Dember LM, et al. Healthy lifestyle and risk of kidney disease progression, atherosclerotic events, and death in CKD: findings from the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis. 2015;65:412–24.

    Article  PubMed  Google Scholar 

  36. van Dam RM, Li T, Spiegelman D, Franco OH, Hu FB. Combined impact of lifestyle factors on mortality: prospective cohort study in US women. BMJ. 2008;337:a1440.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Emoto M, Nishizawa Y, Maekawa K, Hiura Y, Kanda H, Kawagishi T, et al. Homeostasis model assessment as a clinical index of insulin resistance in type 2 diabetic patients treated with sulfonylureas. Diabetes Care. 1999;22:818–22.

    Article  CAS  PubMed  Google Scholar 

  38. Bonora E, Targher G, Alberiche M, Bonadonna RC, Saggiani F, Zenere MB, et al. Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: studies in subjects with various degrees of glucose tolerance and insulin sensitivity. Diabetes Care. 2000;23:57–63.

    Article  CAS  PubMed  Google Scholar 

  39. Wallace TM, Levy JC, Matthews DR. Use and abuse of HOMA modeling. Diabetes Care. 2004;27:1487–95.

    Article  PubMed  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan

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

  2. Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan

    Toshiaki Ohkuma

  3. Diabetes Center, Hakujyuji Hospital, Ishimaru 3-2-1, Nishi-ku, Fukuoka, 819-8511, Japan

    Masanori Iwase & Yasuhiro Idewaki

  4. Division of General Internal Medicine, School of Oral Health Science, Kyushu Dental University, Manazuru 2-6-1, Kokurakita-ku, Kitakyushu, 803-8580, Japan

    Hiroki Fujii

Authors
  1. Toshiaki Ohkuma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masanori Iwase
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiroki Fujii
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hitoshi Ide
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shinako Kaizu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tamaki Jodai
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yohei Kikuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yasuhiro Idewaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Akiko Sumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Udai Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Takanari Kitazono
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masanori Iwase.

Ethics declarations

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.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

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

Keywords

Search

Navigation