Hu Huanhuan, Hori Ai, Nishiura Chihiro, Sasaki Naoko, Okazaki Hiroko, Nakagawa Tohru, Honda Toru, Yamamoto Shuichiro, Tomita Kentaro, Miyamoto Toshiaki, Nagahama Satsue, Uehara Akihiko, Yamamoto Makoto, Murakami Taizo, Shimizu Chii, Shimizu Makiko, Eguchi Masafumi, Kochi Takeshi, Imai Teppei, Okino Akiko, Kuwahara Keisuke, Kashino Ikuko, Akter Shamima, Kurotani Kayo, Nanri Akiko, Kabe Isamu, Mizoue Tetsuya, Kunugita Naoki, Dohi Seitaro
Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan.
Tokyo Gas Co., Ltd., Tokyo, Japan.
PLoS One. 2016 Jul 20;11(7):e0159071. doi: 10.1371/journal.pone.0159071. eCollection 2016.
The control of blood glucose levels, blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) levels reduces the risk of diabetes complications; however, data are scarce on control status of these factors among workers with diabetes. The present study aimed to estimate the prevalence of participants with diabetes who meet glycated hemoglobin (HbA1c), BP, and LDL-C recommendations, and to investigate correlates of poor glycemic control in a large working population in Japan.
The Japan Epidemiology Collaboration on Occupational Health (J-ECOH) Study is an ongoing cohort investigation, consisting mainly of employees in large manufacturing companies. We conducted a cross-sectional analysis of 3,070 employees with diabetes (2,854 men and 216 women) aged 20-69 years who attended periodic health examinations. BP was measured and recorded using different company protocols. Risk factor targets were defined using both American Diabetes Association (ADA) guidelines (HbA1c < 7.0%, BP < 140/90 mmHg, and LDL-C < 100 mg/dL) and Japan Diabetes Society (JDS) guidelines (HbA1c < 7.0%, BP < 130/80 mmHg, and LDL-C < 120 mg/dL). Logistic regression models were used to explore correlates of poor glycemic control (defined as HbA1c ≥ 8.0%).
The percentages of participants who met ADA (and JDS) targets were 44.9% (44.9%) for HbA1c, 76.6% (36.3%) for BP, 27.1% (56.2%) for LDL-C, and 11.2% (10.8%) for simultaneous control of all three risk factors. Younger age, obesity, smoking, and uncontrolled dyslipidemia were associated with poor glycemic control. The adjusted odds ratio of poor glycemic control was 0.58 (95% confidence interval, 0.46-0.73) for participants with treated but uncontrolled hypertension, and 0.47 (0.33-0.66) for participants with treated and controlled hypertension, as compared with participants without hypertension. There was no significant difference in HbA1c levels between participants with treated but uncontrolled hypertension and those with treated and controlled hypertension.
Data from a large working population, predominantly composed of men, suggest that achievement of HbA1c, BP, and LDL-C targets was less than optimal, especially in younger participants. Uncontrolled dyslipidemia was associated with poor glycemic control. Participants not receiving antihypertensive treatment had higher HbA1c levels.
控制血糖水平、血压（BP）和低密度脂蛋白胆固醇（LDL-C）水平可降低糖尿病并发症的风险；然而，关于糖尿病患者这些因素控制情况的数据却很稀少。本研究旨在估计符合糖化血红蛋白（HbA1c）、血压和LDL-C推荐标准的糖尿病参与者的比例，并调查日本一大规模工作人群中血糖控制不佳的相关因素。
日本职业健康流行病学协作研究（J-ECOH研究）是一项正在进行的队列研究，主要由大型制造企业的员工组成。我们对3070名年龄在20 - 69岁、参加定期健康检查的糖尿病员工（2854名男性和216名女性）进行了横断面分析。血压按照不同公司的方案进行测量和记录。危险因素目标依据美国糖尿病协会（ADA）指南（HbA1c < 7.0%，BP < 140/90 mmHg，LDL-C < 100 mg/dL）和日本糖尿病学会（JDS）指南（HbA1c < 7.0%，BP < 130/80 mmHg，LDL-C < 120 mg/dL）来定义。采用逻辑回归模型探索血糖控制不佳（定义为HbA1c≥8.0%）的相关因素。
符合ADA（及JDS）目标的参与者比例分别为：HbA1c为44.9%（44.9%），血压为76.6%（36.3%），LDL-C为27.1%（56.2%），同时控制所有三个危险因素的为11.2%（10.8%）。年龄较小、肥胖、吸烟和血脂异常未得到控制与血糖控制不佳相关。与无高血压的参与者相比，接受治疗但血压未得到控制的参与者血糖控制不佳的调整比值比为0.58（95%置信区间，0.46 - 0.73），接受治疗且血压得到控制的参与者为0.47（0.33 - 0.66）。接受治疗但血压未得到控制的参与者与接受治疗且血压得到控制的参与者之间HbA1c水平无显著差异。
来自以男性为主的大规模工作人群的数据表明，HbA1c、血压和LDL-C目标的达成情况不尽人意，尤其是在年轻参与者中。血脂异常未得到控制与血糖控制不佳相关。未接受抗高血压治疗的参与者HbA1c水平较高。
