Long work hours is associated with suboptimal glycemic control among US workers with diabetes

Aging on the Job? The Association Between Occupational Characteristics and Accelerated Biological Aging

OBJECTIVES

There is a common belief that demanding jobs can make workers age faster, but there is little empirical evidence linking occupational characteristics to accelerated biological aging. We examine how occupational categorizations and self-reported working conditions are associated with expanded biological age, which incorporates 22 biomarkers and captures physiologic dysregulation throughout several bodily systems.

METHODS

Data are from 1,133 participants in the Health and Retirement Study who were aged 51-60 and working for pay in the 2010 or 2012 wave and who participated in the 2016 Venous Blood Study. We estimate associations between occupational category (professional/managerial, sales/clerical, service, and manual) and self-reported working conditions (psychosocial demands, job control, heavy lifting, and working 55 or more hours per week) and expanded biological age.

RESULTS

Compared to same-age individuals working in professional or managerial positions, those working in service jobs appear 1.65 years older biologically even after adjusting for social and economic characteristics, self-reported working conditions, health insurance, and lifestyle-related risk factors. Low job control is associated with 1.40 years, heavy lifting with 2.08 years, and long working hours with 1.87 years of accelerated biological aging.

DISCUSSION

Adverse occupational characteristics held at midlife, particularly service work, low job control, heavy lifting, and long work hours, are associated with accelerated biological aging. These findings suggest that work may be important for the overall aging process beyond its associations with specific diseases or risk factors.

Association between occupation type and development of type 2 diabetes: A population-based Panasonic cohort study 3

Background

Due to a lack of investigation on the association between the type of occupation and the development of type 2 diabetes among Japanese individuals, we aimed to assess this association in 98,935 Japanese individuals.

Methods

This long-term retrospective cohort study included participants selected from medical health checkup programs conducted at the Panasonic Corporation, Osaka, Japan, from 2008 to 2018. Cox regression analyses were used to evaluate the association between occupation type and the incidence of type 2 diabetes.

Results

From 2008 to 2018, 5,008 participants developed type 2 diabetes. The proportion of never smokers, those with slow eating speeds, and those working with a flextime system was higher in men with technical jobs than in salespersons, manufacturers, and office workers (p < 0.0001). Cox regression analyses revealed that occupation type was associated with an increased probability of type 2 diabetes development in men but not in women. Multivariate analyses showed that the hazard ratios were 1.15 [95% confidence interval (CI), 1.05-1.26], 1.20 (95% CI, 1.10-1.30), and 1.11 (95% CI, 1.02-1.21) in men working as salespersons, manufacturers, and office workers, respectively (reference group: men with technical jobs). On the other hand, the occupation type was not associated with the development of type 2 diabetes in women.

Conclusions

This study demonstrated that occupation type might be an independent factor in the development of type 2 diabetes in Japanese men.

Association Between Long Working Hours and Chronic Kidney Disease According to Diabetic Status: A Nationwide Study (Korean National Health and Nutrition Examination Survey 2010-2017)

OBJECTIVE

This study aimed to investigate the relationship between long working hours and chronic kidney disease (CKD) according to diabetic status.

METHODS

Twelve thousand seven hundred three full-time employees without diabetes and 2136 with diabetes were included in this study. Participants were grouped according to working hours: ≤40, 41 to 52, and >52 h/week. Multiple logistic regression was used to evaluate the association between working hours and CKD prevalence.

RESULTS

Participants with diabetes who worked 41 to 52 h/week showed 1.85 times higher odds of CKD (95% CI 1.15-2.96; P = 0.0112) compared with those who worked ≤40 h/week after adjusting for covariates. An interaction between diabetes and long working hours was observed (P for interaction = 0.0212) in the model.

CONCLUSION

Long working hours are associated with CKD in participants with diabetes. An interaction between long working hours and diabetes leading to CKD development may exist.

Poor glycemic control in workers with diabetes mellitus in relation to long working hours: a cross-sectional study

We aimed to investigate the association between working hours and poor glycemic control using a cross-sectional data from the Korea National Health and Nutrition Examination Survey (KNHANES). The participants who were medically diagnosed with diabetes mellitus by a physician were defined as diabetic patients, and patients with hemoglobin A1c (HbA1c) levels >9.0% were considered as "poorly controlled". The association of HbA1c level with working hours was examined by linear regression plot, using local regression line and logistic regression analyses. The local regression plot showed a smooth increasing pattern: the longer were the working hours, the higher were the HbA1c levels, even though it was not statistically significant. Odds ratios of working hours over 52 h per week were higher with the criterion of poor diabetic control (HbA1c >9.0%). The results were significant in elderly female workers (odds ratio 3.30, 95% confidence interval 1.19-9.18). Long working hours were associated with poor glycemic control, specifically among elderly female workers with diabetes.

Systematic review and meta-analysis of patient race/ethnicity, socioeconomics, and quality for adult type 2 diabetes

OBJECTIVE

To review the evidence of the association between performance in eight indicators of diabetes care and a patient's race/ethnicity and socioeconomic characteristics.

DATA SOURCE

Studies of adult patients with type 2 diabetes in MEDLINE published between January 1, 2000, and December 31, 2018.

STUDY DESIGN

Systematic review and meta-analysis of regression-based studies including race/ethnicity and income or education as explanatory variables. Meta-analysis was used to quantify differences in performance associated with patient race/ethnicity or socioeconomic characteristics. The systematic review was used to identify potential mechanisms of disparities.

DATA COLLECTION

Two coauthors separately conducted abstract screening, study exclusions, data extraction, and scoring of retained studies. Estimates in retained studies were extracted and, where applicable, were standardized and converted to odds ratios and standard errors.

PRINCIPAL FINDINGS

Performance in intermediate outcomes and process measures frequently exhibited differences by race/ethnicity even after adjustment for socioeconomic, lifestyle, and health factors. Meta-analyses showed black patients had lower odds of HbA1c and blood pressure (BP) control (OR range: 0.67-0.68, P < .05) but higher odds of receiving eye or foot examination (OR range: 1.22-1.47, P < .05) relative to white patients. A high school degree or more was associated with higher odds of HbA1c control and receipt of eye examinations compared to patients without a degree. Meta-analyses of income included a handful of studies and were inconsistently associated with diabetes care performance. Differences in diabetes performance appear to be related to access-related factors such as uninsurance or lacking a usual source of care; food insecurity and trade-offs at very low incomes; and lower adherence among younger and healthier diabetes patients.

CONCLUSIONS

Patient race/ethnicity and education were associated with differences in diabetes quality measures. Depending on the approach used to rate providers, not adjusting for these patient characteristics may penalize or reward providers based on the populations they serve.

Long working hours and skipping breakfast concomitant with late evening meals are associated with suboptimal glycemic control among young male Japanese patients with type 2 diabetes

AIMS/INTRODUCTION

To assess the associations of working conditions, eating habits and glycemic control among young Japanese workers with type 2 diabetes.

MATERIALS AND METHODS

This hospital- and clinic-based prospective study included 352 male and 126 female working patients with diabetes aged 20-40 years. Data were obtained from June to July 2012 and June to July 2013. Logistic regression analysis was used to estimate multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for suboptimal glycemic control (glycosylated hemoglobin level of ≥7%) obtained from June to July 2013.

RESULTS

Multivariable logistic regression analysis showed that disease duration of ≥10 years (OR 2.43, 95% CI 1.02-5.80), glycosylated hemoglobin level of ≥7% in 2012 (OR 8.50, 95% CI 4.90-14.80), skipping breakfast and late evening meals (OR 2.50, 95% CI 1.25-5.00) and working ≥60 h/week (OR 2.92, 95% CI 1.16-7.40) were predictive of suboptimal glycemic control in male workers, whereas a glycosylated hemoglobin level of ≥7% in 2012 (OR 17.96, 95% CI 5.93-54.4), oral hyperglycemic agent therapy (OR 12.49, 95% CI 2.75-56.86) and insulin therapy (OR 11.60, 95% CI 2.35-57.63) were predictive of suboptimal glycemic control in female workers.

CONCLUSIONS

Working ≥60 h/week and habitual skipping breakfast concomitant with late evening meals might affect the ability of young male workers with type 2 diabetes to achieve and maintain glycemic control.

Development of a Diabetes Mellitus Knowledge Resource for Clinical Decision Support Assisting Primary Care Physicians With Work-Related Issues

OBJECTIVE

The aim of this study was to describe the process by which a group of subject matter experts (SMEs) in the area of occupational health and primary care developed a clinical decision support (CDS) tool addressing work-related issues, which are important in the care of patients with diabetes mellitus (DM). The CDS is intended for primary care clinicians caring for employed adults with DM.

METHODS

The SME's selected guidelines for the management of DM in working adults, reviewed pertinent literature, and developed specific recommendations for action in the clinical setting.

RESULTS

Multiple factors at work may adversely affect DM management. Clinicians can support working patients through education and care strategies to improve control.

CONCLUSION

Improved recognition of factors at work that can have an impact on DM care provides opportunities for improved management of DM among working adults.

Association between secondhand smoke and glycemic control in adult diabetes patients

Diabetes is a major chronic disease, and many studies have shown an association between diabetes with severe complications and certain causes of diabetes, including secondhand smoke. Smoking has been considered a significant issue around the world, and research has been conducted on its relationship with diseases including diabetes. However, previous studies have focused on the onset of diabetes, rather than glycemic control in patients with diabetes. Thus, this study aims to provide evidence of a relationship between secondhand smoke and glycemic control. We conducted a cross-sectional study using data from the Korea National Health and Nutrition Examination Survey (2007-2014). We included 1168 male and 1248 female survey participants. Exposure to secondhand smoke at home and/or at workplaces was considered the primary independent variable, and glycemic control was represented by HbA1c levels. Chi-squared tests and logistic regression analysis were performed to evaluate the association. A significant association was found between secondhand smoke and glycemic control (male at home, odds ratio [OR]: 0.36, 95% confidence interval [CI]: 0.14-0.90; female at both locations, OR: 0.29, 95% CI: 0.11-0.74). The sub-group analysis showed a negative association of diabetes management with secondhand smoke in both sexes, regardless of income status or healthy/unhealthy behaviors. Exposure to secondhand smoke at home was revealed as a risk factor for poor glycemic control. Thus, healthcare providers should help diabetes patients to avoid secondhand smoke by educating them on the dangers of secondhand smoke.

Diazepam potentiates the antidiabetic, antistress and anxiolytic activities of metformin in type-2 diabetes mellitus with cooccurring stress in experimental animals

Psychological stress is considered as one of the limiting factors in the management of type-2 diabetes mellitus (T2DM). Therefore, the basic objective of the present study was to evaluate the antidiabetic effect of metformin, diazepam, and their combination in cooccurring T2DM and stress condition (DMS). T2DM was induced in the male rats by administering streptozotocin (45 mg/kg, i.p.) and nicotinamide (110 mg/kg, i.p.) with time lag of 15 min. Rats were subjected to two sessions of cold restraint stress paradigm for one hour on the sixth and seventh day after streptozotocin injection. Administration of metformin (25 mg/kg, p.o.) and diazepam (1 mg/kg, p.o.) in combination from the seventh to thirteenth day after streptozotocin injection showed better improvement in glucose tolerance and insulin sensitivity compared to monotherapy of either drug. In addition, the combination significantly attenuated DMS-induced hyperglycemia, hypertriglyceridaemia, hypercorticosteronemia, anxiety-like behavior, and insulin resistance through modulating insulin signaling pathway in the liver compared to monotherapy. Further, improvement of mitochondrial function, integrity, and oxidative stress in hippocampus, hypothalamus, prefrontal cortex, striatum, amygdala, and nucleus accumbens was observed with the combination. Therefore, metformin in combination with diazepam may be a better therapeutic option in the management of T2DM with cooccurring stress condition.

Associations of work hours and actual availability of weekly rest days with cardiovascular risk factors

OBJECTIVES

The aim of study was to determine the associations of work hours and actual availability of weekly rest days with the onset of lifestyle-related diseases such as obesity, hypertension, hypertriglyceridemia, low levels of high-density lipoprotein (HDL) cholesterol and hyperglycemia.

METHODS

For this longitudinal study, we used data from checkups conducted in 1999 and 2006 for 30,194 men who worked for a local public institution in Japan. We calculated the cumulative incidence rates of onset of obesity, hypertension, hyperglycemia, hypertriglyceridemia and low HDL cholesterol over this 7-year period and performed a χ2 test to determine the association between the above diseases and work conditions (work hours and actual availability of weekly rest days) at the time of the baseline survey. We then performed multiple logistic regression analysis of the diseases that showed significant associations.

RESULTS

The adjusted odds ratio for the onset of hypertriglyceridemia in subjects who worked ≥9 hours was high (1.11 [95% CI: 1.02-1.22], p=0.02) in comparison with those who worked <9 hours. The adjusted odds ratio for the onset of hypertriglyceridemia in subjects who could not often take weekly rest days was high (1.13 [95% CI: 1.01-1.27], p=0.03) in comparison with those who were able to take most of the available weekly rest days off work.

CONCLUSIONS

These results show that work hours and actual availability of weekly rest days independently predict the onset of hypertriglyceridemia. Working only regular hours and taking advantage of weekly rest days can contribute to the prevention of hypertriglyceridemia.