Hba1c, Blood Pressure, and Lipid Control in People with Diabetes: Japan Epidemiology Collaboration on Occupational Health Study

PLoS One. 2016 Jul 20;11(7):e0159071. doi: 10.1371/journal.pone.0159071. eCollection 2016.

Abstract

Aims: 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.

Methods: 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%).

Results: 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.

Conclusion: 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.

MeSH terms

  • Adult
  • Aged
  • Antihypertensive Agents / pharmacology
  • Antihypertensive Agents / therapeutic use
  • Blood Pressure* / drug effects
  • Cooperative Behavior*
  • Diabetes Mellitus / blood*
  • Diabetes Mellitus / epidemiology*
  • Diabetes Mellitus / physiopathology
  • Female
  • Glycated Hemoglobin / analysis*
  • Humans
  • Hypolipidemic Agents / pharmacology
  • Hypolipidemic Agents / therapeutic use
  • Japan / epidemiology
  • Lipids / blood*
  • Male
  • Middle Aged
  • Occupational Health*
  • Prevalence
  • Risk Factors
  • Young Adult

Substances

  • Antihypertensive Agents
  • Glycated Hemoglobin A
  • Hypolipidemic Agents
  • Lipids

Grants and funding

This study was supported by the Industrial Health Foundation and Industrial Disease Clinical Research Grants (140202-01, 150903-01). “Tokyo Gas Co., Ltd.”, “Mitsubishi Fuso Truck and Bus Corporation”, “Mitsui Chemicals, Inc.”, “Hitachi, Ltd.”, “Mitsubishi Plastics, Inc.”, “Nippon Steel & Sumitomo Metal Corporation Kimitsu Works”, “YAMAHA CORPORATION”, “Furukawa Electric Co., Ltd.” and “Azbil Corporation” provided support in the form of salaries for authors [A. Hori, C. Nishiura, N. Sasaki, H. Okazaki, S. Dohi, T. Nakagawa, T. Honda, S. Yamamoto, K. Tomita, T. Miyamoto, A. Uehara, M. Yamamoto, M. Eguchi, T. Kochi, I. Kabe, T. Imai, and A. Okino], but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.