Active and passive exposure to tobacco smoke in relation to insulin sensitivity and pancreatic β-cell function in Japanese subjects

Clinical characteristics and complication risks in data-driven clusters among Chinese community diabetes populations

BACKGROUND

Novel diabetes phenotypes were proposed by the Europeans through cluster analysis, but Chinese community diabetes populations might exhibit different characteristics. This study aims to explore the clinical characteristics of novel diabetes subgroups under data-driven analysis in Chinese community diabetes populations.

METHODS

We used K-means cluster analysis in 6369 newly diagnosed diabetic patients from eight centers of the REACTION (Risk Evaluation of cAncers in Chinese diabeTic Individuals) study. The cluster analysis was performed based on age, body mass index, glycosylated hemoglobin, homeostatic modeled insulin resistance index, and homeostatic modeled pancreatic β-cell functionality index. The clinical features were evaluated with the analysis of variance (ANOVA) and chi-square test. Logistic regression analysis was done to compare chronic kidney disease and cardiovascular disease risks between subgroups.

RESULTS

Overall, 2063 (32.39%), 658 (10.33%), 1769 (27.78%), and 1879 (29.50%) populations were assigned to severe obesity-related and insulin-resistant diabetes (SOIRD), severe insulin-deficient diabetes (SIDD), mild age-associated diabetes mellitus (MARD), and mild insulin-deficient diabetes (MIDD) subgroups, respectively. Individuals in the MIDD subgroup had a low risk burden equivalent to prediabetes, but with reduced insulin secretion. Individuals in the SOIRD subgroup were obese, had insulin resistance, and a high prevalence of fatty liver, tumors, family history of diabetes, and tumors. Individuals in the SIDD subgroup had severe insulin deficiency, the poorest glycemic control, and the highest prevalence of dyslipidemia and diabetic nephropathy. Individuals in MARD subgroup were the oldest, had moderate metabolic dysregulation and the highest risk of cardiovascular disease.

CONCLUSION

The data-driven approach to differentiating the status of new-onset diabetes in the Chinese community was feasible. Patients in different clusters presented different characteristics and risks of complications.

Global trends in deaths and disability-adjusted life years of diabetes attributable to second-hand smoke and the association with smoke-free policies

OBJECTIVES

The diabetic burden attributable to second-hand smoke (SHS) is a global public health challenge. We sought to explore the diabetic burden attributable to SHS by age, sex, and socioeconomic status during 1990-2019 and to evaluate the health benefit of smoke-free policies on this burden.

STUDY DESIGN

Cross-sectional study.

METHODS

The diabetic burden attributable to SHS was extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 dataset. Country-level smoke-free policies were obtained from the World Health Organization Global Health Observatory. The deaths or disability-adjusted life years (DALYs) were quantified, and the average annual percentage changes were calculated. Hierarchical linear mixed models were applied to evaluate the health effects.

RESULTS

From 1990 to 2019, the absolute number of global deaths and DALYs of diabetes attributable to SHS has doubled, and the age-standardised rate has significantly increased. The disease burden was higher in females than in males and increased with increasing age. The SHS-related diabetic burden varied across regions and countries. Age-standardised death or DALY rates first increased and then decreased with increased Socio-demographic Index (SDI), peaking in the 0.60-0.70 range. In low to low-middle, and middle to high-middle SDI countries, SHS-related diabetic deaths and DALYs were significantly lower in countries with more than 3 smoke-free public places than in countries with 0-2 smoke-free public places.

CONCLUSIONS

More attention should be paid to females and the elderly, who bear a heavy SHS-related diabetic burden. Banning smoking in public places was associated with reduced burden of SHS-attributable diabetes, especially in low to middle social development countries.

Association of environmental tobacco smoke exposure with metabolic syndrome: A longitudinal Cohort Study of 71,055 never smokers

BACKGROUND AND AIMS

Effects of environmental tobacco smoke (ETS) exposure and a change in ETS exposure status on metabolic syndrome (MetS) remain unknown. Thus, the aim of this study was to evaluate the effect of ETS exposure on MetS in self-reported and cotinine-validated never smokers.

METHODS AND RESULTS

From a large longitudinal cohort study, 71,055 cotinine-validated never smokers without MetS at baseline were included. These participants were divided into four groups (no, new, former, and continuous ETS exposure groups) based on their ETS exposure status at baseline and follow-up. The association between ETS exposure and MetS was assessed using multivariable Cox hazard regression analyses. During a median follow-up of 33 months, 15.0 cases/10,000 person-years (PY) developed MetS. Incidence rates per 10,000 PY of MetS in no, new, former, and continuous ETS exposure groups were 14.0, 18.5, 16.5, and 19.0, respectively. In multivariable Cox hazard regression analyses, the new and continuous ETS exposure groups showed increased risk of MetS compared to the no ETS exposure group (hazard ratio [95% confidence interval]: 1.35 [1.16, 1.56], p-value < 0.001 for the new ETS exposure group and 1.19 [1.06, 1.34], p-value = 0.004 for the continuous ETS exposure group). However, the former ETS exposure group did not show an increased risk of MetS (0.96 [0.88, 1.05], p-value = 0.36).

CONCLUSION

This study showed that ETS exposure and changes in ETS exposure status over approximately three years could modify the risk of MetS, suggesting that avoidance of ETS may not increase the risk of incidence of MetS.

Is job strain associated with a higher risk of type 2 diabetes mellitus? A systematic review and meta-analysis of prospective cohort studies

Objectives:

Epidemiological studies have explored the relationship between work-related stress and the risk of type 2 diabetes mellitus (T2DM), but it remains unclear on whether work-related stress could increase the risk of T2DM. We aimed to evaluate the association between job strain and the risk of T2DM.

Methods:

We searched PubMed and Web of Science up to April 2019. Summary risk estimates were calculated by random-effect models. And the analysis was also conducted stratifying by gender, study location, smoking, drinking, body mass index, physical activity, family history of T2DM, education and T2DM ascertainment. Studies with binary job strain and quadrants based on the job strain model were analyzed separately.

Results:

A total of nine studies with 210 939 participants free of T2DM were included in this analysis. High job strain (high job demands and low control) was associated with the overall risk of T2DM compared with no job strain (all other combinations) [relative risk (RR) 1.16, 95% confidence interval (CI) 1.03–1.31], and the association was more evident in women (RR 1.48, 95% CI 1.02–2.14). A statistically significant association was also observed when using high strain as a category (job strain quadrants) rather than binary variable (RR 1.62, 95% CI 1.04–2.55) in women but not men.

Conclusions:

Our study suggests that job strain is an important risk factor for T2DM, especially among women. Appropriate preventive interventions in populations with high job strain would contribute to a reduction in T2DM risk.

Cigarette smoking exposure breaks the homeostasis of cholesterol and bile acid metabolism and induces gut microbiota dysbiosis in mice with different diets

Exposure of humans to second-hand smoking (SHS) increases glucose and lipid metabolic disorders. The link of hepatic metabolic dysfunction to environmental cigarette smoking has been noticed, but the related mechanism is still unclear. C57BL/6 mice with normal food diet (NFD) or high fat diet (HFD) were exposed to 15 min cigarette smoking twice a day in a 0.038 m³ box for 4 weeks, and the concentration of nicotine in the air of the box was 21.05 mg/m³ during the smoke exposure. Liver tissues and serum were collected for gene expression and biochemistry test. The fecal microbiota was also checked through 16S rDNA sequences. Cigarette smoking exposure increased the accumulation of total cholesterol (TC) in liver, and the expression of cholesterol synthesis-related genes was upregulated. The expression of CYP8B1 protein was significantly down-regulated, and the ratio of cholic acid (CA) to chenodeoxycholic acid (CDCA) was significantly reduced in the liver of mice exposed to cigarette smoking especially for HFD group. Cigarette smoking exposure caused insulin resistance in the liver of mice with HFD. The composition of the gut microbiota was altered with the exposure of cigarette smoking, and the change of the distribution of primary bile acids might be one of the reasons. It was concluded that cigarette smoking would break the homeostasis of cholesterol and bile acids metabolism and changed the composition of gut microbiota. Our discoveries confirmed that smoking bans are important for the public health.

Alcohol-induced impaired insulin secretion in a Japanese population: 5-year follow up in the Gifu Diabetes Study

AIMS/INTRODUCTION

Although moderate alcohol consumption lowers the risk of type 2 diabetes in European populations, the same cannot be assumed for Japanese patients with diabetes related to low insulin secretion rather than resistance. We aimed to evaluate the effects of daily alcohol consumption on glucose tolerance and diabetes development risk in Japanese populations.

MATERIALS AND METHODS

This retrospective study randomly enrolled 452 men and 659 women aged 40-78 years in 2005 (Gifu, Japan). The participants completed a 75-g oral glucose tolerance test and medical questionnaire. The homeostasis model assessment of insulin resistance, homeostasis model assessment of β-cell function and insulinogenic index were used to estimate insulin sensitivity and secretion. The relationships between alcohol consumption and these parameters were analyzed using logistic regression after adjusting for potential confounders. The 5-year changes in hemoglobin A1c levels were also evaluated.

RESULTS

The adjusted odds ratios for elevated homeostasis model assessment of β-cell function values (<40%) in the 0-19.9 g/day, 20.0-39.9 g/day and ≥ 40 g/day alcohol consumption groups were 0.98, 1.46 and 2.68, respectively. Alcohol consumption induced a significant decrease in the insulin secretion level among the ≥40 g/day drinkers, especially in men. However, there was no risk of increased insulin resistance based on the homeostasis model assessment of insulin resistance (<2.5) results. The 5-year risk of elevated hemoglobin A1c levels (≥6.5%) was increased according to increase in alcohol consumption in both men and women.

CONCLUSIONS

Daily alcohol consumption was associated with reduced insulin secretion and an increased diabetes development risk in Japanese populations.

Passive smoking and type 2 diabetes among never-smoking women: The Japan Public Health Center-based Prospective Study

AIMS/INTRODUCTION

The aim of the current study was to prospectively evaluate the association between passive smoking from a spouse and the risk of diabetes among never-smoking Japanese women. Passive smoking at a workplace (or public facilities) was assessed as a secondary measure.

MATERIALS AND METHODS

In the Japan Public Health Center-based Prospective Study (baseline 1990 or 1993), we followed 25,391 never-smoking women aged 40-69 years and without diabetes. Passive smoking was defined as having a husband who was a self-reported smoker, and the exposure at a workplace (or public facilities) was self-reported by women. The development of diabetes was identified in questionnaires administered at the 5-year and 10-year surveys. A pooled logistic regression model was used to assess the association between passive smoking and the development of diabetes with adjustment for age and possible confounders.

RESULTS

Compared with women whose husbands had never smoked, women whose husband smoked ≥40 cigarettes/day had significantly higher odds of developing diabetes in an age-adjusted model, but the association was attenuated in a multivariable model (odds ratio 1.34, 95% confidence interval 0.96-1.87). There was a dose-response trend between the number of cigarettes smoked by a husband and the odds of developing diabetes (P = 0.02). Women reporting daily passive smoking at a workplace (or public facilities) had higher odds of developing diabetes than women reporting no such exposure (odds ratio 1.23, 95% confidence interval 0.995-1.53).

CONCLUSIONS

Our results indicated a higher risk of diabetes among never-smoking Japanese women with higher exposure to passive smoking from a spouse.

Secondhand Smoke Correlates with Elevated Neutrophil-Lymphocyte Ratio and Has a Synergistic Effect with Physical Inactivity on Increasing Susceptibility to Type 2 Diabetes Mellitus: A Community-Based Case Control Study

Secondhand smoke (SHS) and physical inactivity are thought to be associated with type 2 diabetes mellitus (T2DM), but the synergistic effect of SHS with physical inactivity and their relationships with T2DM–associated inflammation biomarkers have not been estimated. We investigated the roles of SHS exposure and physical inactivity and their synergistic effect on T2DM risk and their relationships with T2DM associated inflammation biomarkers, neutrophil–lymphocyte ratio (NLR) and white blood cells (WBCs). A case–control study was conducted in total 588 participants (294 case T2DM and 294 healthy controls) from five community clinics in Indonesia. Participants completed a standardized questionnaire on demographic information, smoking status, physical activity habits and food consumption. WBCs and NLR levels were determined using an automated hematology analyzer. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were analyzed using multiple logistic regression model. The synergistic effect was analyzed using additive interaction for logistic regression. Physical inactive people exposed to SHS exhibited a synergistically increased 7.78-fold risk of T2DM compared with people who were not exposed to SHS and who were physically active. SHS is significantly correlated with a high NLR, WBCs and has a synergistic effect with physical inactivity on increasing susceptibility to T2DM.

[Treatment of diabetic foot with vaccum sealing drainage combined with transverse tibial bone transport]

OBJECTIVE

To summarize the effectiveness and experience of Wanger grade 3-5 diabetic foot treated with vacuum sealing drainage (VSD) combined with transverse tibial bone transport.

METHODS

Between March 2015 and January 2018, 21 patients with refractory diabetic foot who failed conservative treatment were treated with VSD combined with transverse tibial bone transport. There were 15 males and 6 females, aged 55-88 years (mean, 65 years). The diabetes history was 8-15 years (mean, 12.2 years). The duration of diabetic foot ranged from 7 to 84 days (mean, 35.3 days). The size of diabetic foot ulcer before operation ranged from 2 cm×2 cm to 8 cm×5 cm. According to Wanger classification, 8 cases were rated as grade 3, 11 cases as grade 4, and 2 cases as grade 5. Among the 21 cases, angiography of lower extremity before operation was performed in 5 cases, CT angiography of lower extremity in 16 cases, all of which indicated that the arteries below the knee were narrowed to varying degrees and not completely blocked. Preoperative foot skin temperature was (29.28±0.77)℃, C-reactive protein was (38.03±31.23) mg/L, leukocyte count was (9.44±2.21)×10 9/L, and the visual analogue scale (VAS) score was 6.8±1.5, and ability of daily living (Barthel index) was 54.3±10.3.

RESULTS

After operation, 2 patients with Wanger grade 4 and smoking history failed treatment and had an major amputation (amputation above ankle joint) at 30 days and 45 days after operation, respectively. One patient with Wanger grade 5 and chronic heart failure died of cardiac arrest at 60 days after operation. The remaining 18 patients were followed up 6-24 months (mean, 9.2 months). The external fixator was removed at 40-62 days after operation, with an average of 46 days. All the wounds healed, with a healing time of 50-120 days (mean, 62.5 days). The pain of 18 patients' feet was relieved obviously, and there was no recurrence of ulcer in situ or other parts. There was no complication such as tibial fracture and ischemic necrosis of lower leg skin after operation. After ulcer healing, the foot skin temperature was (30.86±0.80)℃, C-reactive protein was (22.90±18.42) mg/L, VAS score was 2.4±1.2, and Barthel index was 77.3±4.6, all showing significant differences when compared with preoperative ones ( P<0.05); the leukocyte count was (8.91±1.72)×10 9/L, showing no significant difference ( t=1.090, P=0.291).

CONCLUSION

VSD combined with transverse tibial bone transport can effectively promote the healing of Wanger grade 3-5 diabetic foot wounds, but smokers, unstable blood glucose control, and chronic heart failure patients have the risk of failure.

Association between environmental tobacco smoke exposure and risk of type 2 diabetes mellitus in Chinese female never smokers: A population-based cohort study

BACKGROUND

Evidence for the association between environmental tobacco smoke (ETS) exposure and the risk of type 2 diabetes mellitus (T2DM) is limited. The aim of this study was to investigate this association in female never smokers.

METHODS

We analyzed 28 177 female participants of the China Kadoorie Biobank (CKB) in the Suzhou area, who were never smokers and had no diabetes. ETS exposure was defined as being exposed to other people's tobacco smoke either at home, workplace, or in public places at least 1 d/wk. Cox proportional hazard regression models were used to assess the association between ETS exposure and incident T2DM according to the frequency and duration of ETS exposure.

RESULTS

A total of 774 incident cases of T2DM were identified during a median 7.3-year follow-up. Compared with no ETS exposure, hazard ratios (95% CIs) for all ETS exposure, daily, and ≥14 h/wk ETS exposure were 1.17 (1.00-1.37), 1.23 (1.04-1.46), and 1.25 (1.03-1.53), respectively. Moreover, a positive dose-response relationship was observed between ETS exposure level and T2DM (all P <.05 for trend).

CONCLUSIONS

This prospective study suggests that ETS exposure increases the risk of T2DM incidence with dose-response relationship in female never smokers. Thus, reducing ETS exposure may help decrease the burden of T2DM in Chinese females.

Knowledge of diabetes and its determinants: a cross-sectional study among adults in a Japanese community

OBJECTIVE

To assess general knowledge of diabetes and its determinants among adult men and women in a Japanese community.

SETTING

A cross-sectional study with the residential registry in Gifu City. Blood tests were conducted to measure fasting blood glucose levels and the levels after 2 hours of a 75-gram oral glucose load. Participants' previous diagnosis of diabetes and demographic status were identified from a questionnaire. A validated food frequency questionnaire was also administered. To assess the association between good knowledge of diabetes and the level of each factor, a logistic regression was utilised with adjustments for age, education and parental history of diabetes.

PARTICIPANTS

A total of 1019 men and women aged 40-78 years.

PRIMARY OUTCOME MEASURE

The Diabetes Knowledge Questionnaire was administered. Participants with ≥75% of answers correct were defined as having a good knowledge of diabetes.

RESULTS

Previous diagnosis of diabetes was significantly associated with good knowledge of diabetes (OR=2.36; 95% CI 1.19 to 4.68). Among individuals with no previous diagnosis of diabetes, age ≥60 years (OR=0.55; 95% CI 0.36 to 0.86, p value for trend=0.02) and education <12 years (OR=0.54; 95% CI 0.30 to 0.97) were significantly associated with low knowledge of diabetes. The highest tertile intakes of green-yellow vegetables (OR=1.77; 95% CI 1.07 to 2.91, p value for trend=0.03) and seafood (OR=1.76; 95% CI 1.04 to 2.95, p value for trend=0.03) were associated with high knowledge of diabetes.

CONCLUSIONS

Some diabetes risk factors were implied to determine the general knowledge of diabetes. Conducting further studies of knowledge in various populations is warranted.

Age Differences in the Relationship between Secondhand Smoke Exposure and Risk of Metabolic Syndrome: A Meta-Analysis

Secondhand smoke (SHS), a common environmental exposure factor, has become a serious public health problem. Metabolic syndrome is another worldwide clinical challenge. Our study tried to determine the age differences in the relationship between SHS and the risk of metabolic syndrome. Studies were searched in PubMed and Web of Science from 11 November to 30 November 2018. Eighteen studies were finally included based on inclusion and exclusion criteria. The relationship between SHS and the risk indicators of metabolic syndrome was analyzed. The weighted mean difference (WMD) of fasting plasma glucose (FPG), insulin, body mass index (BMI), and waist circumference (WC), and the standard mean difference (SMD) of total cholesterol, triglycerides, and low- and high-density lipoprotein-cholesterol (LDL-C, HDL-C) were calculated in a meta-analysis. SHS was positively associated with the level of insulin and WC. According to the subgroup analysis based on age difference, SHS was positively associated with FPG in the upper age group, and positively associated with LDL-C and negatively associated with HDL-C in the lower age group. BMI showed a more obvious positive correlation in the adults group than in the children and the teenagers group. In conclusion, the association of metabolic syndrome with SHS varies with age. When exposed to SHS, older people may be more susceptible to glucose metabolic disorder, but younger people may be more susceptible to lipid metabolic disorder.

The incidence rate of diabetes mellitus (type II) and its related risk factors: A 10-year longitudinal study of Yazd Healthy Heart Cohort (YHHC), Iran

BACKGROUND AND OBJECTIVES

Diabetes Mellitus (DM) is a metabolic disease characterized by chronic hyperglycemia, which occurs due to insufficient production of insulin by the pancreas or resistance to insulin produced by the body. The most dangerous and Long-term complications of diabetes include renal failure, heart failure, cardiovascular disease, stroke, diabetic foot ulcers, and diabetic neuropathy.

MATERIALS AND METHODS

This longitudinal cohort study was conducted on 1641 non-diabetic people of 2000 participants enrolled in phase I of Yazd Healthy Heart project (YHHP) aged 20-74 year-old resident of the city of Yazd. They were selected randomly through cluster sampling method and included in follow up a project for ten years (2004-2014). In order to analyze the data, Chi-Square, independent t-test and logistic regression statistical models were used through the SPSS Ver₂₀.

RESULTS

The incidence rate of DM type II among the people aged 20-74 years in Yazd was 21.4 per 1000 of a population-year. Univariate analysis revealed that the relative risk of DM incidence increased by smoking, increasing BMI, abdominal obesity, hypertension, and increased cholesterol, triglyceride and uric acid levels (p < 0.0001). Variables with a significant p-value < 0.05 using the univariate analysis were included in the logistic regression model. Age, family history of diabetes mellitus in relatives, abdominal obesity, triglyceride values greater than 150 and uric acid more than the 75th percentile were recognized as independent risk factors of diabetes.

CONCLUSION

In the present study, Age, family history of DM, abdominal obesity, high triglycerides, and high uric acid are the most important risk factors for diabetes.

A Case-Control Study on Risk Factors and Their Interactions with Prediabetes among the Elderly in Rural Communities of Yiyang City, Hunan Province

BACKGROUND

The prevalence of prediabetes has been increasing significantly in recent years. Individuals with prediabetes have an increased risk of developing diabetes and cardiovascular diseases. The objectives of this study were to identify risk factors for prediabetes and their interactions among the elderly in rural communities of Hunan Province and to provide a scientific basis for prediabetes prevention.

METHODS

A case-control study was conducted to explore risk factors for prediabetes among the elderly in rural areas. The general sociodemographic information, lifestyle behaviours, and physiological results of elderly individuals with prediabetes and controls were collected by a questionnaire and laboratory testing. Conditional logistic regression was performed to identify the risk factors for prediabetes among the elderly, and additive interactions were used to analyse the interactions between risk factors.

RESULTS

A total of 425 elderly subjects with prediabetes were included in the case group, and 425 elderly subjects with normal plasma glucose levels were included in the control group. The main risk factors for prediabetes among the elderly in rural communities of Hunan Province were a family history of diabetes (OR = 2.48; 95% CI: 1.13, 5.46), physical inactivity (OR = 3.27; 95% CI: 1.95, 5.49), a lack of health literacy on diabetes prevention and control (OR = 3.26; 95% CI: 1.62, 6.55), hypertension (OR = 2.01; 95% CI: 1.38, 2.93), overweight (OR = 2.53; 95% CI: 1.67, 3.81), obesity (OR = 3.08; 95% CI: 1.48, 6.40), and a high waist-to-hip ratio (WHR) (OR = 2.26; 95% CI: 1.45, 3.51). Additive interactions for prediabetes were detected between a high WHR and physical inactivity, with a relative excess risk due to interaction (RERI) of 6.30 (95% CI: 0.42, 12.18), and between a high WHR and overweight or obesity, with an RERI of 2.92 (95% CI: 0.56, 5.29).

CONCLUSION

The independent risk factors for prediabetes are a family history of diabetes, physical inactivity, a lack of health literacy on diabetes prevention and control, hypertension, overweight or obesity, and a high WHR. A high WHR has additive interactions with physical inactivity and overweight or obesity for the risk of prediabetes. These findings have significant implications for prediabetes prevention among the elderly in rural areas.

Psychological distress and type 2 diabetes mellitus: a 4-year policemen cohort study in China

OBJECTIVES

This study investigated whether psychological distress predicts the development of type 2 diabetes mellitus (T2DM) and if the association differs between populations at a high or low diabetes risk level among Chinese police officers.

DESIGN

Prospective cohort study.

SETTING

Single centre.

PARTICIPANTS

6559 participants underwent clinical measurements at the hospital in April 2007. 5811 police officers participated in the follow-up consisting of new-onset diabetes (NOD) events occurring annually between 2008 and 2011.

PRIMARY OUTCOME MEASURES

Baseline data were collected from policemen who completed the Symptom Checklist 90-Revised (SCL-90-R) questionnaire and a self-designed questionnaire. Psychological distress was measured by the SCL-90-R questionnaire. Hong Kong Chinese Diabetes Risk Score (HKCDRS) was used to evaluate the risk of T2DM, and the participants were divided into low-risk group and high-risk group based on the HKCDRS. Cox proportional hazards regression was used to calculate the HRs of the incidence of T2DM related to psychological distress and further stratified the analysis based on HKCDRS.

RESULTS

Among 5811 participants, 179 subjects developed NOD during the 4-year follow-up. 54 subjects (1.63%) with a HKCDRS 0-7 vs 125 subjects (4.98%) with a HKCDRS>7 developed NOD (p<0.05). There was a significant association between psychological distress and T2DM (HR=1.46; 95% CI 1.05 to 2.02). Among the participants with a high-risk score (HKCDRS>7), 7.07% of those with psychological distress developed T2DM compared with 4.43% of participants without psychological distress (p<0.05). The corresponding adjusted HR for psychological distress was 1.61 (95% CI 1.10 to 2.37).

CONCLUSIONS

Psychological distress is an independent risk factor for T2DM in this prospective cohort study. Stratification analysis indicated that psychological distress was associated with T2DM in a high-risk level population.

Associations of smoking and alcohol consumption with impaired β-cell function in Chinese men

BACKGROUND

The aims of the present study were to examine the association of cigarette smoking and alcohol consumption with impaired β-cell function in Chinese men, particularly the interaction of smoking and alcohol consumption on impaired insulin secretion.

METHODS

A population-based cross-sectional study was performed in 3957 Chinese men aged ≥40 years. The homeostatic model assessment of β-cell function (HOMA-β) was calculated, and impaired β-cell function was defined as less than the lowest quartile HOMA-βcut-off point.

RESULTS

The prevalence of impaired β-cell function in current smokers and heavy drinkers (≥200 g/week) was significantly higher than in non-smokers and non-drinkers, respectively. Compared with non-smoking, current smoking had an exacerbating relationship with impaired β-cell function (odds ratio [OR] 1.78; 95% confidence interval [CI] 1.47-2.15; P < 0.001). No significant association was found between impaired β-cell function and former smoking (P = 0.21), although low and heavy drinking were associated with an increased risk of impaired β-cell function (OR 1.40 [95% CI 1.07-1.81] and 2.14 [95% CI 1.77-2.58], respectively) compared with non-drinking. The combination of current smoking and heavy drinking was associated with the highest risk of impaired β-cell function (OR 3.16; 95% CI 2.43-4.12; P < 0.0001) after adjustment for confounders. We did not detect an additive interaction between current smoking and heavy drinking on the association with impaired β-cell function.

CONCLUSIONS

Cigarette smoking and alcohol consumption were significantly and independently associated with impaired β-cell function in Chinese men.

Association between occupational stressors and type 2 diabetes among Chinese police officers: a 4-year follow-up study in Tianjin, China

PURPOSE

To explore the relationship between occupational stressors and the incidence of type 2 diabetes mellitus among police officers.

METHODS

Baseline data were collected from policemen who completed the Occupational Stress Inventory-Revised (OSI-R) questionnaire, a self-designed questionnaire, and underwent free clinical measurements at the Medical Center of Police Hospital in Tianjin, China, in April 2007. A total of 5811 policemen participated in follow-up with the dynamic observation of new-onset diabetes (NOD) events occurring annually between 2008 and 2011. Occupational stress was measured by the OSI-R questionnaire, which contains 14 different scales. Cox proportional hazards regression was used to calculate the hazard ratios (HR) of the incidence of type 2 diabetes mellitus (T2DM) by occupational stressors.

RESULTS

A total of 3.1% of the participants (n = 179) developed NOD in the follow-up period from 2008 to 2011, and the incidence rates of NOD were 0.58% in 2008, 0.98% in 2009, 0.52% in 2010, and 1.01% in 2011. Role overload (RO), role boundary (RB), physical environment (PE), interpersonal strain (IS), and physical strain (PHS) were associated with the incidence of T2DM (RO: HR = 1.574, 95% CI = 1.071-2.372; RB: HR = 1.645, 95% CI = 1.144-2.365; PE: HR = 2.292, 95% CI = 1.545-3.400; IS: HR = 1.537, 95% CI = 1.079-2.191; and PHS: HR = 1.680, 95% CI = 1.167-2.006) after adjustment for confounding factors. A subgroup Cox regression analysis among traffic control police officers showed the specific work stressors remained robust except RO.

CONCLUSIONS

Several aspects of stressors were independent predictors of T2DM in a prospective cohort study in Tianjin, China. This practical information can be applied to the development of psychological interventions against T2DM.