Lifestyles and Cardiovascular Factors of Diabetic Patients

A Lum Han; Sae-Ron Shin; Hyerin Park

doi:10.4093/jkd.2015.16.1.56

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Han, Shin, and Park: Lifestyles and Cardiovascular Factors of Diabetic Patients

Original Article

J Korean Diabetes 2015;16(1):56-64.

Published online: 20 January 2015

DOI: https://doi.org/10.4093/jkd.2015.16.1.56

Lifestyles and Cardiovascular Factors of Diabetic Patients

A Lum Han, Sae-Ron Shin, Hyerin Park

Department of Family Medicine, Wonkwang University Hospital, Iksan, Korea

Corresponding author: Sae-Ron Shin Department of Family Medicine, Wonkwang University Hospital, 895 Muwang-ro, Iksan 570-711, Korea, E-mail: devilron@naver.com

Received 8 August 2014 Revised 12 November 2014 Accepted 15 December 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

There are many studies on lifestyle management of diabetic patients, but few provide sufficient data comparing a diabetic group with an abnormal fasting glucose group and a normal, non-diabetic group. In this study, we compare the lifestyle management of diabetic patients with those of others groups.

Methods

Among patients visiting the health promotion center of a single university hospital, we retrospectively collected medical records and survey responses regarding patient information.

Results

No difference was found in smoking status or smoking intake among the three groups. Alcohol consumption was high in the diabetes group, followed by the abnormal fasting glucose group and the normal group. The diabetes group reported a higher frequency of exercise per week than the normal group. With regard to systolic BP, both the diabetes and abnormal fasting glucose groups were higher than the normal group, with a level greater than the therapeutic goal of 130 mmHg. Both the diabetes group and the abnormal fasting glucose group had a higher triglyceride level than the normal group, with a measure greater than the therapeutic goal of 150 mg/d. The diabetes group had a higher highly sensitive C-reactive protein level than other two groups, with a level greater than 1 mg/dL.

Conclusion

Management of smoking and alcohol consumption is not sufficient in diabetes patients, suggesting the need for tighter control of BP and triglyceride level in such individuals. For these patients, follow-up of highly sensitive C-reactive protein level should also be considered.

Keywords: Cardiovascular factor, Diabetes, Lifestyle

References

1. Kim SG, Choi DS. Epidemiology and current status of diabetes in Korea. Hanyang Med Rev. 2009; 29:122–9.

2. Statistics Korea: Death rate for the 10 leading causes of death 2006. Korea National Statistical Office Korea National Statistical Office. Available from:. http://kostat. go.kr/portal/korea/index.action(updated 2008 Jul 12).

3. American Diabetes Association. Implications of the United Kingdom prospective diabetes study. Diabetes Care. 2000; 23(Suppl 1):S27–31.

4. Lee JE, Park HA, Kang JH, Lee SH, Cho YG, Song HR, Kim SW, Lee JS. State of diabetes care in Korean adults: according to the American Diabetes Association Recommendations. J Korean Acad Fam Med. 2008; 29:658–67.

5. Church TS, Cheng YJ, Earnest CP, Barlow CE, Gibbons LW, Priest EL, Blair SN. Exercise capacity and body composition as predictors of mortality among men with diabetes. Diabetes Care. 2004; 27:83–8.

6. Whelton SP, Chin A, Xin X, He J. Effect of aerobic exercise on blood pressure: a metaanalysis of randomized, controlled trials. Ann Intern Med. 2002; 136:493–503.

7. Kraus WE, Houmard JA, Duscha BD, Knetzger KJ, Wharton MB, McCartney JS, Bales CW, Henes S, Samsa GP, Otvos JD, Kulkarni KR, Slentz CA. Effects of the amount and intensity of exercise on plasma lipoproteins. N Engl J Med. 2002; 347:1483–92.

8. Lim KB, Lee R, Ko KN, Choi EY, Kim JH, Cheong YS, Park EW, Kim JT, Kim JS, Kim KS, Sim SK, Kang KH, Park YJ. Self-care for diabetic patients in primary care. J Korean Acad Fam Med. 2007; 28:106–13.

9. Frier BM. Diabetes mellitus and lifestyle. Pickup JC, Gareth W, editors. Textbook of diabetes. 3th ed.Oxford: Blackwell;2003. p68.1.

10. Haire-Joshu D, Glasgow RE, Tibbs TL. Smoking and diabetes. Diabetes Care. 1999; 22:1887–98.

11. Deedwania PC. Hypertension and diabetes: new therapeutic options. Arch Intern Med. 2000; 160:1585–94.

12. Chambers JC, Obeid OA, Refsum H, Ueland P, Hackett D, Hooper J, Turner RM, Thompson SG, Kooner JS. Plasma homocysteine concentrations and risk of coronary heart disease in UK Indian Asian and European men. Lancet. 2000; 355:523–7.

13. Tsai WC, Li YH, Tsai LM, Chao TH, Lin LJ, Chen TY, Chen JH. Correlation of homocytsteine levels with the extent of coronary atherosclerosis in patients with low cardiovascular risk profiles. Am J Cardiol. 2000; 85:49–52.

14. Ogawa M, Abe S, Saigo M, Biro S, Toda H, Matsuoka T, Torii H, Minagoe S, Maruyama I, Tei C. Homocysteine and hemostatic disorder as a risk factor for myocardial infarction at a young age. Thromb Res. 2003; 109:253–8.

15. Passaro A, Calzoni F, Volpato S, Nora ED, Pareschi PL, Zamboni PF, Fellin R, Solini A. Effect of metabolic control on homocysteine levels in type 2 diabetic patients: a 3-year follow-up. J Intern Med. 2003; 254:264–71.

16. Fonseca VA, Fink LM, Kern PA. Insulin sensitivity and plasma homocysteine concentrations in non-diabetic obese and normal weight subjects. Atherosclerosis. 2003; 167:105–9.

17. Stanger O, Herrmann W, Pietrzik K, Fowler B, Geisel J, Dierkes J, Weger M. DACH-LIGA Homocystein e.V. DACH-LIGA homocystein (german, austrian and swiss homocysteine society): consensus paper on the rational clinical use of homocysteine, folic acid and B-vitamins in cardiovascular and thrombotic diseases: guidelines and recommendations. Clin Chem Lab Med. 2003; 41:1392–403.

18. Ridker PM, Glynn RJ, Hennekens CH. C-reactive protein adds to the predictive value of total and HDL cholesterol in determining risk of first myocardial infarction. Circulation. 1998; 97:2007–11.

19. Danesh J, Collins R, Appleby P, Peto R. Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: metaanalyses of prospective studies. JAMA. 1998; 279:1477–82.

20. Koenig W, Sund M, Fröhlich M, Fischer HG, Löwel H, Döring A, Hutchinson WL, Pepys MB. C-Reactive protein, a sensitive marker of inflammation, predicts future risk of coronary heart disease in initially healthy middle-aged men: results from the MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) Augsburg Cohort Study, 1984 to 1992. Circulation. 1999; 99:237–42.

21. Ridker PM, Buring JE, Shih J, Matias M, Hennekens CH. Prospective study of C-reactive protein and the risk of future cardiovascular events among apparently healthy women. Circulation. 1998; 98:731–3.

22. McPherson RA, Pincus MR. Henry's clinical diagnosis and management by laboratory methods. 21th ed.Philadelphia: Elsevier Health Sciences;2006.

23. Stocker DJ, Taylor AJ, Langley RW, Jezior MR, Vigersky RA. A randomized trial of the effects of rosiglitazone and metformin on inflammation and subclinical atherosclerosis in patients with type 2 diabetes. Am Heart J. 2007; 153:445.e1–6.

24. Davignon J. Beneficial cardiovascular pleiotropic effects of statins. Circulation. 2004; 109(23 Suppl 1):III39–43.

25. Qian Y, Lin Y, Zhang T, Bai J, Chen F, Zhang Y, Luo S, Shen H. The characteristics of impaired fasting glucose associated with obesity and dyslipidaemia in a Chinese population. BMC Public Health. 2010; 10:139.

26. Zhang L, Qiao Q, Tuomilehto J, Hammar N, Alberti KG, Eliasson M, Heine RJ, Stehouwer CD, Ruotolo G. DECODE Study Group. Blood lipid levels in relation to glucose status in European men and women without a prior history of diabetes: the DECODE Study. Diabetes Res Clin Pract. 2008; 82:364–77.

27. Chen LK, Lin MH, Chen ZJ, Hwang SJ, Tsai ST, Chiou ST. Metabolic characteristics and insulin resistance of impaired fasting glucose among the middle-aged and elderly Taiwanese. Diabetes Res Clin Pract. 2006; 71:170–6.

Table 1.

General characteristics of the study groups

		Normal FSG (a)	First detected abnormal FSG (b)	DM on therapy (c)	P-value^a	Scheffe
Age (years)		44.1 ± 8.8	45.8 ± 7.7	51.5 ± 8.6	0.000	a, b < c
Sex	Male	313 (61.4)	76 (79.2)	26 (86.7)	0.000
	Female	197 (38.6)	20 (20.8)	4 (13.3)
BMI (kg/m²)		23.7 ± 3.0	24.6 ± 2.9	24.9 ± 3.4	0.004	a < b
WC (cm)		79.7 ± 9.0	83.2 ± 8.1	84.6 ± 8.6	0.000	a < b, c
Metabolic syndrome	Yes	31 (6.1)	18 (18.8)	10 (33.3)	0.000
	No	479 (93.9)	78 (81.3)	20 (66.7)

Value are presented as number (%) or mean ± SD. SD, standard deviation; FSG, fasting serum glucose; DM, diabetes mellitus; BMI, body mass index; WC, waist circumference.

^a Continuous variables were analyzed with one-way analysis of variance (ANOVA) test, and post hoc analysis used the Scheffe test. Categorical variables were analyzed using the Chi-square test.

Table 2.

Comparison of smoking, alcohol intake, and exercise among the study groups

		Normal FSG (a)	First detected abnormal FSG (b)	DM on therapy (c)	P-value^a	Scheffe
Smoking status	Yes	120 (23.5)	33 (34.4)	8 (26.7)	0.080
Smoking status	No	390 (76.5)	63 (65.6)	22 (73.3)
Smoking number of cigarettes day (cigarettes/day)		3.9 ± 7.8	5.9 ± 9.3	4.3 ± 7.4	0.070
Alcohol intake	Yes	243 (47.6)	56 (58.3)	22 (73.3)	0.006
Alcohol intake	No	267 (52.4)	40 (41.7)	8 (26.7)
Frequency of alcohol intake per week		0.8 ± 1.1	1.1 ± 1.3	1.5 ± 1.5	0.003	a < c
Alcohol consumption (bottle of Soju/wk)		0.9 ± 1.9	1.5 ± 2.5	1.9 ± 2.8	0.004	a < b, c
Exercise	Yes	236 (46.3)	47 (49.0)	20 (66.7)	0.091
Exercise	No	274 (53.7)	49 (51.0)	10 (33.3)
Exercise per week		1.2 ± 1.5	1.3 ± 1.7	2.0 ± 1.7	0.026	a < c
Amount of exercise (minute/wk)		73.5 ± 94.2	80.6 ± 104.4	122.0 ± 103.9	0.026	a < c

Value are presented as number (%) or mean ± SD. SD, standard deviation; FSG, fasting serum glucose; DM, diabetes mellitus.

^a Continuous variables were analyzed with one-way analysis of variance (ANOVA), and post hoc analysis used the Scheffe test. Categorical variables were analyzed using the Chi-square test.

Table 3.

Comparison of cardiovascular risk factors among the study groups

	Normal FPG (a)	First detected abnormal FPG (b)	DM (c)	P	Scheffe	P^a	P^b		P^c
							a vs b	a vs c	a vs b	b vs c
SBP (mmHg)	121.1 ± 16.1	131.7 ± 17.2	132.3 ± 3.3	0.000	a < b, c	0.000	0.000	0.014	0.000	0.701
DBP (mmHg)	73.0 ± 10.8	80.0 ± 13.6	77.3 ± 8.2	0.000	a < b	0.000	0.000	0.370	0.000	0.082
TC (mg/dL)	192.2 ± 32.8	201.5 ± 30.6	173.2 ± 34.0	0.000	a, c < b a < c	0.000	0.145	0.000	0.145	0.000
TG (mg/dL)	113.9 ± 67.2	152.0 ± 103.1	157.4 ± 84.7	0.001	a < b, c	0.000	0.001	0.011	0.001	0.593
HDL-C (mg/dL)	52.2 ± 11.5	49.8 ± 9.5	45.2 ± 11.0	0.000	a > c	0.012	0.311	0.004	0.311	0.035
LDL-C (mg/dL)	121.1 ± 30.0	126.3 ± 30.6	101.5 ± 28.5	0.000	a, b > c	0.000	0.643	0.000	0.643	0.000
Hcy (mg/d^L)	9.7 ± 3.2	10.7 ± 3.5	10.3 ± 3.2	0.019	a < b	0.314	0.143	0.816	0.143	0.320
LogHcy	0.9 ± 0.1	1.0 ± 0.1	0.9 ± 0.1	0.008	a < b	0.281	0.131	0.744	0.131	0.270
hsCRP (mg/L)	0.8 ± 1.2	0.9 ± 0.9	1.7 ± 2.3	0.001	a, b < c	0.009	0.543	0.004	0.543	0.003
LoghsCRP	–0.2 ± 0.3	–0.1 ± 0.3	0.0 ± 0.4	0.000	a < c	0.020	0.433	0.006	0.433	0.036

Value are presented as number (%) or mean ± SD. SD, standard deviation; FPG, fasting plasma glucose; DM, diabetes mellitus; SBP, systolic blood pressure; DBP, diastolic blood pressure; TC, total cholesterol; TG, triglycerides; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; Hcy, homocystein; hsCRP, highly sensitive C-reactive protein. P value was determined by one-way analysis of variance (ANOVA), and post hoc analysis used the Scheffe test.

^a P value was determined by analysis of covariance (ANCOVA) after adjusting for age, body mass index, waist circumference, alcohol consumption (bottles of Soju/week), smoking intake per day, and amount of exercise (minutes/week).

^b P value was determined using the Simple Contrast test.

^c P value was determined using the Repeated Contrast test.

Table 4.

Abnormally controlled cardiovascular risk factors among the study groups

	Normal FPG (a)	First detected abnormal FPG (b)	DM on therapy (c)	P
SBP ≥ 130	196 (38.4)	64 (66.7)	22 (73.3)	0.000
DBP	62 (12.2)	28 (29.2)	4 (13.3)	0.000
TC	192 (37.6)	71 (74.0)	13 (43.3)	0.036
TG	124 (24.3)	34 (35.4)	15 (50.0)	0.001
HDL-C	116 (22.7)	18 (18.8)	11 (36.7)	0.000
LDL-C	178 (34.9)	76 (79.2)	17 (56.7)	0.000
Hcy	84 (16.5)	26 (27.1)	7 (23.3)	0.037
hsCRP
1∼3	86 (16.9)	25 (26.0)	12 (40.0)
≥ 3	24 (4.7)	6 (6.3)	4 (13.3)	0.001

Value are presented as number (%). SD, standard deviation; FPG, fasting plasma glucose; DM, diabetes mellitus; SBP, systolic blood pressure; DBP, diastolic blood pressure; TC, total cholesterol; TG, triglycerides; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; Hcy, homocystein; hsCRP, highly sensitive C-reactive protein. P value was determined using the Chi-square test.

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