Journal of Preventive Medicine and Public Health

Original Articles

The Development of an Assessment Instrument for Behavior Toward Hypoglycemia Risk Among Type 2 Diabetes Mellitus Outpatients in Jakarta, Indonesia: Putu Rika Veryanti, Rani Sauriasari, Ratu Ayu Dewi Sartika, Berna Elya, Muhammad Ikhsan Mokoagow; J Prev Med Public Health. 2025;58(1):31-43. Published online November 13, 2024; DOI: https://doi.org/10.3961/jpmph.24.313

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Abstract Summary PDF Supplementary Material: Objectives
The purpose of this study was to develop a valid and reliable instrument for assessing patients’ behavior toward the risk of hypoglycemia through self-assessment. Insufficient education and supervision of type 2 diabetes mellitus (DM) outpatients by healthcare providers is a significant concern, affecting their behavior during the treatment process. Additionally, inappropriate behavior typically increases the risk of hypoglycemia. To mitigate this risk, several studies have recommended evaluating patients’ behavior, necessitating the development of a new instrument.
Methods
The study procedures were conducted in 3 stages: instrument development (face and content validity, stage I), construct validity and reliability test (stage II), and criterion validity (stage III). Stage I involved 5 healthcare practitioners, including internal medicine doctors, nurses, dietitians, and pharmacists in hospitals and community health centers. Stage II included 20 respondents using a 1-shot test method. Stage III involved 237 type 2 DM outpatients at Central General Hospital (RSUP) in Jakarta, employing a cross-sectional design and consecutive sampling.
Results
The results indicated that the developed instrument was valid and reliable, comprising 9 domains (29 questions). These domains included behavior toward blood glucose monitoring, diet, physical activity, medication, assistance from healthcare providers, hypoglycemia management, self-care, family support, and insulin use. Furthermore, poor behavior was found to increase the risk of hypoglycemia by 2.36 times.
Conclusions
Based on these results, the developed instrument could be effectively used to evaluate behavior toward hypoglycemia among type 2 DM outpatients, confirming its validity and reliability.; Summary

Key Message
The development of an assessment instrument for behavior toward hypoglycemia risk among type 2 diabetes mellitus outpatients in Jakarta, Indonesia have been carried out. The instrument contains 9 domains, included behavior toward blood glucose monitoring, diet, physical activity, medication, assistance from healthcare providers, hypoglycemia management, self-care, family support, and insulin use. Poor behavior was found to increase the risk of hypoglycemia by 2.36 times. The instrument developed is valid and reliable.

Development and Validation of an Instrument to Assess the Safe Use of Antidiabetic Medication to Prevent Hypoglycemia Requiring Hospitalization Among Ambulatory Patients With Type 2 Diabetes Mellitus in Bali, Indonesia: Made Krisna Adi Jaya, Fita Rahmawati, Nanang Munif Yasin, Zullies Ikawati; J Prev Med Public Health. 2025;58(1):52-59. Published online October 24, 2024; DOI: https://doi.org/10.3961/jpmph.24.424

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Abstract Summary PDF: Objectives
Ambulatory patients with type 2 diabetes mellitus (T2DM) require special attention when being discharged from the hospital with anti-diabetes medication. This necessity stems primarily from the risk of adverse drug reactions, particularly hypoglycemia. However, this risk is significantly influenced by the patients’ knowledge and behavior regarding their medication use. This study aimed to develop instrument to assess the risk of medication-related hypoglycemia in ambulatory T2DM patients by clinical pharmacists.
Methods
The study was conducted using an observational design that included multiple stages. These stages involved item development through focus group discussions (FGDs), content validation by clinical pharmacists, and criterion and construct validation by ambulatory T2DM patients using a cross-sectional approach.
Results
A total of 10 question items were developed for assessment by clinical pharmacists following FGDs and content validation. Criterion and construct validation identified 8 valid question items through multivariate analysis (p<0.05). The scoring system developed demonstrated a linear relationship between the score and the number of items at risk in the instrument (p<0.05, R²=0.988). Additionally, the instrument was named “Medication-related Hypoglycemia Risk Score Assessment Tools (HYPOGLYRISK).”
Conclusions
The findings of this study suggest that HYPOGLYRISK may serve as a useful tool for clinical pharmacists to evaluate the risk of medication-related hypoglycemia in ambulatory T2DM patients. Additionally, this instrument could assist clinical pharmacists in identifying priority patients and tailoring educational services to meet their specific goals and needs.; Summary

Key Message
- HYPOGLYRISK is an instrument that can be used to assess the risk of hypoglycemia requiring hospitalization in T2DM patients. This instrument met all the requirements for psychometric properties testing in this study. - Patients discharged on antidiabetic medications can be screened for risk of severe hypoglycemia using HYPOGLYRISK, specifically by pharmacists, during drug dispensing. - Patients with T2DM must be ensured to have knowledge related to the five dimensions of medication safety to avoid the risk of hypoglycemia requiring hospitalization.

Healthcare Utilization and Discrepancies by Income Level Among Patients With Newly Diagnosed Type 2 Diabetes in Korea: An Analysis of National Health Insurance Sample Cohort Data: Eun Jee Park, Nam Ju Ji, Chang Hoon You, Weon Young Lee; J Prev Med Public Health. 2024;57(5):471-479. Published online August 20, 2024; DOI: https://doi.org/10.3961/jpmph.24.165

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Abstract Summary PDF

Objectives
The use of qualitative healthcare services or its discrepancy between different income levels of the type 2 diabetes (T2D) patients has seldom been studied concurrently. The present study is unique that regarding T2D patients of early stages of diagnosis. Aimed to assess the utilization of qualitative healthcare services and influence of income levels on the inequality of care among newly diagnosed patients with T2D.
Methods
A retrospective cohort study of 7590 patients was conducted by the National Health Insurance Service National Sample Cohort 2.0 from 2002 to 2015. Insured employee in 2013 with no history of T2D between 2002 and 2012 were included. The standard of diabetes care includes hemoglobin A1c (HbAlc; 4 times/y), eyes (once/y) and lipid abnormalities (once/y). Multivariate logistic regression analysis was performed to examine the difference between income levels and inequality of care.
Results
From years 1 to 3, rates of appropriate screening fell from 16.9% to 14.1% (HbA1c), 15.8% to 14.5% (eye), and 59.2% to 33.2% (lipid abnormalities). Relative to income class 5 (the highest-income group), HbA1 screening was significantly less common in class 2 (year 2: odds ratio [OR], 0.78; 95% confidence interval [CI], 0.61 to 0.99; year 3: OR, 0.79; 95% CI, 0.69 to 0.91). In year 1, lipid screening was less common in class 1 (OR, 0.84; 95% CI, 0.73 to 0.98) than in class 5, a trend that continued in year 2. Eye screening rates were consistently lower in class 1 than in class 5 (year 1: OR, 0.73; 95% CI, 0.60 to 0.89; year 2: OR, 0.63; 95% CI, 0.50 to 0.78; year 3: OR, 0.81; 95% CI, 0.67 to 0.99).
Conclusions
Newly diagnosed T2D patients have shown low rate of HbA1c and screening for diabetic-related complications and experienced inequality in relation to receiving qualitative diabetes care by income levels.

Summary

Korean summary
의료서비스 이용의 강도와 질을 측정하는 당뇨 관련 합병증 검진율은 저소득층에서 특히 낮았습니다. 보편적 건강 보장이 있는 국가에서도 신환환자 특히 낮은 경제적 계층의 치료 불균형을 해소 하기 위해서는 재정적 부담은 절감하고, 건강 문해력 증진시키고, 일차의료 기관의 기능을 최적화 하여 책임을 강화하는 것이 필요합니다.

Key Message
Diabetic-related complications screening rates that measure the intensity and quality of medical care service usage were statistically lower in low-income groups. Reducing financial burden, promoting health literacy and optimizing the function of primary care physician and reinforcing the health care provider’s accountability are necessary to address the discrepancy of care for those with low socioeconomic status people in early stage of disease, even in nations with universal health coverage.

Citations

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Older Adults with Diabetes in Korea: Latest Clinical and Epidemiologic Trends
Kyuho Kim, Bongseong Kim, Kyuna Lee, Yu-Bae Ahn, Seung-Hyun Ko, Sung Hee Choi, Kyungdo Han, Jae-Seung Yun
Diabetes & Metabolism Journal.2025; 49(2): 183. CrossRef

The Association Between PM_2.5 Exposure and Diabetes Mellitus Among Thai Army Personnel: Apisorn Laorattapong, Sarun Poobunjirdkul, Thanapoom Thanapoom, Wiroj Jiamjarasrangsi; J Prev Med Public Health. 2023;56(5):449-457. Published online September 26, 2023; DOI: https://doi.org/10.3961/jpmph.23.292

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Abstract Summary PDF Supplementary Material

Objectives
This study investigated the association between baseline exposures to particulate matter with a diameter < 2.5 microns (PM_2.5) and subsequent temporal changes in PM_2.5 exposure with the incidence of type 2 diabetes among Royal Thai Army personnel.
Methods
A retrospective cohort study was conducted using nationwide health check-up data from 21 325 Thai Army personnel between 2018 and 2021. Multilevel mixed-effects parametric survival statistics were utilized to analyze the relationship between baseline (i.e., PM_2.5-baseline) and subsequent changes (i.e., PM_2.5-change) in PM_2.5 exposure and the occurrence of type 2 diabetes. Hazard ratios (HRs) and 95% confidence intervals (CIs) were employed to assess this association while considering covariates.
Results
There was a significant association between both PM_2.5 baseline and PM_2.5-change and the incidence of type 2 diabetes in a dose-response manner. Compared to quartile 1, the HRs for quartiles 2 to 4 of PM_2.5-baseline were 1.11 (95% CI, 0.74 to 1.65), 1.51 (95% CI, 1.00 to 2.28), and 1.77 (95% CI, 1.07 to 2.93), respectively. Similarly, the HRs for quartiles 2 to 4 of PM_2.5-change were 1.41 (95% CI, 1.14 to 1.75), 1.43 (95% CI, 1.13 to 1.81) and 2.40 (95% CI, 1.84 to 3.14), respectively.
Conclusions
Our findings contribute to existing evidence regarding the association between short-term and long-term exposure to PM_2.5 and the incidence of diabetes among personnel in the Royal Thai Army.

Summary

Key Message
We simultaneously investigated the impact of the baseline and temporal variations in the exposure to particulate matter (PM) with a diameter <2.5 microns (PM2.5) on type 2 diabetes risk among the Royal Thai Army personnel. We found stronger evidence on the impact of the temporal variation in PM2.5 exposure on the disease risk than that of the baseline variation. This finding may reflect the shorter time frame between the increased PM2.5 exposure and changes in fasting plasma glucose level.

Citations

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Influence of Air Pollution Exposures on Cardiometabolic Risk Factors: a Review
Li-Hao Guo, Mohammed Zeeshan, Guo-Feng Huang, Duo-Hong Chen, Min Xie, Jun Liu, Guang-Hui Dong
Current Environmental Health Reports.2023; 10(4): 501. CrossRef

Systematic Review

Low Social Support and Risk for Depression in People With Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis: Akhmad Azmiardi, Bhisma Murti, Ratih Puspita Febrinasari, Didik Gunawan Tamtomo; J Prev Med Public Health. 2022;55(1):37-48. Published online January 10, 2022; DOI: https://doi.org/10.3961/jpmph.21.490

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Abstract PDF

Objectives
Depression is a frequent complication of type 2 diabetes mellitus. This study aimed to investigate the relationship between low social support and risk for depression in people with type 2 diabetes through a meta-analysis.
Methods
PubMed, ProQuest, SpringerLink, ScienceDirect, Scopus, the Cochrane Library, Embase, and Google Scholar were searched for English-language articles published up to 2021. Pooled adjusted odds ratios (aORs) were calculated using a random-effect model with 95% confidence intervals (CIs). Heterogeneity was evaluated by using the Cochrane Q test and I² statistics. The risk of publication bias was estimated using a funnel plot, the Egger test, and the Begg test. The Joanna Briggs Institute Critical Appraisal Tools were used to assess the quality of evidence and the risk of bias.
Results
Eleven studies were included in this meta-analysis, containing a total of 3151 people with type 2 diabetes mellitus. The pooled analysis showed that people with type 2 diabetes mellitus who had low social support had twice as high a risk of depression as those with high social support (aOR, 2.02; 95% CI, 1.51 to 2.70; p<0.001). A random-effect model was used because the heterogeneity was high (I²= 87%).
Conclusions
Low social support was found to increase the risk of depression among people with type 2 diabetes mellitus. Further investigation into factors that may moderate this relationship is required.

Summary

Citations

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Original Articles

Objectively Measured Physical Activity of Vietnamese Adults With Type 2 Diabetes: Opportunities to Intervene: Vuong Van Do, Jonine Jancey, Ngoc Minh Pham, Chung Thanh Nguyen, Minh Van Hoang, Andy H. Lee; J Prev Med Public Health. 2019;52(2):101-108. Published online February 22, 2019; DOI: https://doi.org/10.3961/jpmph.18.213

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Abstract PDF

Objectives
To objectively determine and compare the physical activity (PA) levels of adults newly diagnosed with type 2 diabetes (T2D) and adults without T2D in Vietnam using an accelerometer.
Methods
A total of 120 participants with newly diagnosed T2D and 120 adults without T2D were recruited from a large hospital in Hanoi, the capital city of Vietnam. All participants wore an ActiGraph GT3X accelerometer for at least 5 days, including 1 weekend day. Freedson cut-off points were used to estimate different intensities of PA. In addition, comparisons between groups were made with respect to achieving the World Health Organization (WHO) and International Diabetes Federation (IDF) recommended PA guidelines.
Results
Men with T2D had significantly lower levels of PA than men without T2D. The respective multivariable-adjusted mean values of daily step count, daily light-intensity, moderate-intensity, and moderate-to-vigorous-intensity PA were approximately 14%, 19%, and 22% lower in the men with T2D than in their non-T2D counterparts. However, women with T2D accumulated a greater number of steps per day than women without T2D. Only 59.2% of the adults with T2D met the minimum recommended level of PA (WHO and IDF), compared to 74.2% of adults without T2D (p<0.05). After adjusting for potential confounders, participants with T2D experienced 50.0% significantly lower odds of achieving PA recommendations.
Conclusions
Vietnamese men with T2D were less physically active than those without T2D, and adults with T2D were less likely to meet PA guidelines. The results suggest a need for integrating PA into the self-management of this chronic condition.

Summary

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Accelerometer-Measured Physical Activity Data Sets (Global Physical Activity Data Set Catalogue) That Include Markers of Cardiometabolic Health: Systematic Scoping Review
Jonah J C Thomas, Amanda J Daley, Dale W Esliger, Victoria E Kettle, April Coombe, Emmanuel Stamatakis, James P Sanders
Journal of Medical Internet Research.2023; 25: e45599. CrossRef
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Abdullah I Al Shuwaysh, Eduardo L Fabella, Mohammed Al Hassan, Yasser Taher Al Hassan, Abdullah Al Hassan, Hussam Al Majed, Ahmad Al Nahwi, Hassan Al Howayshel, Ali Al Abdi
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Smoking Is Associated With Abdominal Obesity, Not Overall Obesity, in Men With Type 2 Diabetes: Ji Eun Yun, Heejin Kimm, Young Ju Choi, Sun Ha Jee, Kap Bum Huh; J Prev Med Public Health. 2012;45(5):316-322. Published online September 28, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.5.316

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Abstract PDF

Objectives

Abdominal obesity increases mortality and morbidity from cardiovascular disease and there is a possibility that smoking effects obesity. However, previous studies concerning the effects of smoking on obesity are inconsistent. The objective of this study was to examine whether smoking is positively related to abdominal obesity in men with type 2 diabetes.

Methods

Subjects consisted of 2197 type 2 diabetic patients who visited Huh's Diabetes Center from 2003 to 2009. Indices of abdominal obesity were defined as visceral fat thickness (VFT) measured by ultrasonography and waist circumference (WC). Overall obesity was defined as body mass index (BMI).

Results

Statistically significant differences in WC and VFT by smoking status were identified. However, there was no statistical difference in BMI according to smoking status. Means of WC and VFT were not significantly higher in heavy smokers and lower in mild smokers. Compared to nonsmokers, the BMI confounder adjusted odds ratio and 95% confidence interval for VFT in ex-smokers and current-smokers were 1.70 (1.21 to 2.39) and 1.86 (1.27 to 2.73), respectively.

Conclusions

Smoking status was positively associated with abdominal obesity in type 2 diabetic patients.

Summary

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Association between waist circumference or weight change after smoking cessation and incidence of cardiovascular disease or all-cause death in Korean adults with type 2 diabetes
Heajung Lee, Jaeyong Shin, Jae Woo Choi
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Ae Hee Kim, In-Ho Seo, Hye Sun Lee, Yong-Jae Lee
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Su Wang, Jie Chen, Yuzhong Wang, Yu Yang, Danyu Zhang, Chao Liu, Kun Wang
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Maria Piedade Brandão, Margarida Fonseca Cardoso
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Judith Maddatu, Emily Anderson-Baucum, Carmella Evans-Molina
Translational Research.2017; 184: 101. CrossRef
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Yukako Tatsumi, Yoko M Nakao, Izuru Masuda, Aya Higashiyama, Misa Takegami, Kunihiro Nishimura, Makoto Watanabe, Takayoshi Ohkubo, Tomonori Okamura, Yoshihiro Miyamoto
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Kindred K. Harris, Mohan Zopey, Theodore C. Friedman
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Eeva-Liisa Tuovinen, Suoma E. Saarni, Satu Männistö, Katja Borodulin, Kristiina Patja, Taru H. Kinnunen, Jaakko Kaprio, Tellervo Korhonen
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Intraocular Pressure and Its Determinants in Subjects With Type 2 Diabetes Mellitus in India: Sayantan Biswas, Rajiv Raman, Vaitheeswaran Koluthungan, Tarun Sharma; J Prev Med Public Health. 2011;44(4):157-166. Published online July 29, 2010; DOI: https://doi.org/10.3961/jpmph.2011.44.4.157

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Abstract PDF

Objectives

This study was conducted to show the intraocular pressure (IOP) distribution and the factors affecting IOP in subjects with type 2 diabetes mellitus (DM) in India.

Methods

We measured the anthropometric and biochemical parameters for confirmed type 2 DM patients. A comprehensive ocular examination was performed for 1377 subjects aged > 40 years and residing in Chennai.

Results

A significant difference in IOP (mean ± standard deviation) was found between men and women (14.6±2.9 and 15.0±2.8 mmHg, p = 0.005). A significantly elevated IOP was observed among smokers, subjects with systemic hypertension and women with clinically significant macular edema (CSME). After a univariate analysis, factors associated significantly with higher IOP were elevated systolic blood pressure, elevated resting pulse rate and thicker central corneal thickness (CCT). In women, elevated glycosylated hemoglobin was associated with a higher IOP. After adjusting for all variables, the elevated resting pulse rate and CCT were found to be associated with a higher IOP.

Conclusions

Systemic hypertension, smoking, pulse rate and CCT were associated with elevated intraocular pressure in type 2 DM. Women with type 2 DM, especially those with CSME, were more prone to have an elevated IOP.

Summary

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English Abstracts

The Association of Central Obesity with Type 2 Diabetes among Koreans according to the Serum Gamma-Glutamyltransferase Level: Korean Genome and Epidemiology Study.: Ji Yeon Shin, Jun Hyun Hwang, Jin Young Jeong, Sung Hi Kim, Jai Dong Moon, Sang Chul Roh, Young Wook Kim, Yangho Kim, Jong Han Leem, Young Su Ju, Young Seoub Hong, Eun Hee Ha, Yong Hwan Lee, Duk Hee Lee, Dong Hyun Kim; J Prev Med Public Health. 2009;42(6):386-391.; DOI: https://doi.org/10.3961/jpmph.2009.42.6.386

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OBJECTIVES
This cross-sectional study was performed to examine if the serum gamma-glutamyltransferase (GGT) level that is within its normal range is associated with the risk of type 2 diabetes and if the association between the waist hip ratio (WHR) and type 2 diabetes is different depending on the serum GGT levels. METHODS: The study subjects were 23,436 persons aged 40 years or older and who participated in regular health check-ups at 11 hospitals (males: 5,821, females: 17,615). The gender-specific quintiles of the serum GGT and WHR were used to examine the associations with type 2 diabetes. RESULTS: The serum GGT levels within their normal range were positively associated with type 2 diabetes only in women. The adjusted odds ratios (ORs) were 1.0, 1.0, 1.4, 2.1, and 2.5 according to the quintiles of the serum GGT (p(trend)<0.01). The WHR was more strongly associated with the prevalence of diabetes among the women with a high-normal serum GGT level as compared with those with a low-normal serum GGT level (p for interaction=0.02). For example, the adjusted ORs for women with a low normal serum GGT level were 1.0, 1.2, 1.5, 2.2, and 2.4 according to the quintiles of the WHR, while those figures were 1.0, 2.4, 3.6, 5.0, and 8.3 among the women with a high normal serum GGT level. However, in men, the serum GGT was very weakly associated with type 2 diabetes and the association between the WHR and type 2 diabetes was not different depending on the serum GGT level. CONCLUSIONS: Serum GGT within its normal range was positively associated with type 2 diabetes, and central obesity was more strongly associated with the prevalence of type 2 diabetes when the serum GGT level was high-normal. However, these associations were observed only in women, which is different from the previous findings. The stronger relation between central obesity and type 2 diabetes among women with a high-normal serum GGT level can be useful for selecting a group that is at high risk for type 2 diabetes irregardless of whatever the underlying mechanism is.

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Serum gamma-glutamyl transferase and risk of type 2 diabetes in the general Korean population: a Mendelian randomization study
Youn Sue Lee, Yoonsu Cho, Stephen Burgess, George Davey Smith, Caroline L. Relton, So-Youn Shin, Min-Jeong Shin
Human Molecular Genetics.2016; 25(17): 3877. CrossRef
Different associations between obesity and impaired fasting glucose depending on serum gamma-glutamyltransferase levels within normal range: a cross-sectional study
Nam Soo Hong, Jeong-Gook Kim, Yu-Mi Lee, Hyun-Woo Kim, Sin Kam, Keon-Yeop Kim, Ki-Su Kim, Duk-Hee Lee
BMC Endocrine Disorders.2014;[Epub] CrossRef
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Jean-Claude, Lapraz, Kamyar M. Hedayat
Global Advances in Health and Medicine.2013; 2(1): 64. CrossRef

The Effect of Smoking Status upon Occurrence of Impaired Fasting Glucose or Type 2 Diabetes in Korean Men.: Chang Hae Park, Hyuk Ga, Jong Han Leem, Seung Min Kwak, Hwan Cheol Kim, Ji Ho Choi; J Prev Med Public Health. 2008;41(4):249-254.; DOI: https://doi.org/10.3961/jpmph.2008.41.4.249

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OBJECTIVES
To investigate whether smoking and the smoking status are predictors of the incident impaired fasting glucose (IFG) or type 2 diabetes in Korean men. METHODS: A cohort of 1,717 Korean men without IFG or diabetes, who underwent annual periodic health examinations for 4 years (2002-2006), were retrospectively investigated. IFG and diabetes were defined as a serum fasting glucose concentration of 100-125 mg/dL and more than 126 mg/dL, respectively. Cox's proportional hazards model was used to evaluate the association between smoking and development of IFG or type 2 diabetes. RESULTS: A total of 558 cases (32.5%) of incident IFG and 50 cases (2.9%) of diabetes occurred. After controlling for the potential predictors of diabetes, the relative risk for IFG, compared with the never smokers, was 1.02 (95% CI=0.88 to 1.19) for the ever-smokers, 0.96 (95% CI=0.79-1.16) for those who smoked 1-9 cigarettes/d, 1.15 (95% CI=1.01 to 1.30) for those who smoked 10-19 cigarettes/d, and 1.31 (95% CI=1.10 to 1.57) for those who smoked 20 or more cigarettes/d (the P value for the current smokers was only p<0.002). The respective multivariate adjusted relative risks for type 2 diabetes, compared with the neversmokers, were 1.07 (95% CI=0.64 to 1.92), 1.47 (95% CI=0.71 to 3.04), 1.84 (95% CI=0.92-3.04), and 1.87 (95% CI=1.13-3.67), respectively (the P value for the current smokers was only p=0.004). CONCLUSIONS: The smoking status and the number of cigarettes smoked daily are associated with an increased risk for developing IFG or type 2 diabetes in Korean men.

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Health effects associated with smoking: a Burden of Proof study
Xiaochen Dai, Gabriela F. Gil, Marissa B. Reitsma, Noah S. Ahmad, Jason A. Anderson, Catherine Bisignano, Sinclair Carr, Rachel Feldman, Simon I. Hay, Jiawei He, Vincent Iannucci, Hilary R. Lawlor, Matthew J. Malloy, Laurie B. Marczak, Susan A. McLaughlin
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Bernd Kowall, Wolfgang Rathmann, Klaus Strassburger, Margit Heier, Rolf Holle, Barbara Thorand, Guido Giani, Annette Peters, Christine Meisinger
European Journal of Epidemiology.2010; 25(6): 393. CrossRef
Diabetes and impaired fasting glucose in Mongolian population, Inner Mongolia, China
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Diabetes Research and Clinical Practice.2009; 86(2): 124. CrossRef

A Prospective Cohort Study of Exercise and the Incidence of Type 2 Diabetes in Impaired Fasting Glucose Group.: Hong Dae Um, Duck Chul Lee, Sang Yi Lee, Yeon Soo Kim; J Prev Med Public Health. 2008;41(1):45-50.; DOI: https://doi.org/10.3961/jpmph.2008.41.1.45

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OBJECTIVES
To determine the relationship between exercise and the incidence of type 2 diabetes in an impaired fasting glucose group. METHODS: This prospective cohort study was conducted in 19,440 men and 4,297 women, aged 30-69 years, with impaired fasting glucose at baseline who had undergone biennial medical evaluation through the National Health Insurance Corporation from 2000 to 2004. Impaired fasting glucose was defined as fasting glucose of 100 to 125 mg/dl and the subjects were divided into 3 groups depending on weekly exercise frequency. Multivariate logistic regression analysis was used to evaluate the association between the baseline exercise status and incidence of type 2 diabetes. RESULTS: During the 4-year follow-up, a total of 3,239 men and 283 women developed type 2 diabetes, a cumulative incidence of 16.6% for men, and 6.5% for women. Also, 1,688 men (21.2%) and 127 women (15.2%) developed type 2 diabetes in the obese group. The adjusted relative risk (RR) of developing type 2 diabetes in non-exercising men was significantly higher than exercising men regularly (RR= 1.375, 95% CI=1.236-1.529)(p<0.0001), and the RR for non-exercising women was higher than exercising women regularly (RR=1.124, 95% CI=0.711-1.778). The RR for non-exercise men/women in the obese group was 1.571 (95% CI=1.351-1.827)(p<0.0001)/1.869(95% CI=0.846-4.130). CONCLSIONS: Regular exercise is effective in preventing type 2 diabetes in people with impaired fasting glucose, and particularly in obese people. People with risk factors for diabetes should participate in a regular exercise program.

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