Factors associated with serum total homocysteine level in type 2 diabetes

<p><b>OBJECTIVES</b>The aim of this study was to investigate the determinants of serum total homocysteine level (tHcy) in patients with type 2 diabetes mellitus (DM) according to sex.</p><p><b>METHODS</b>A total of 1,276 Japanese, diabetics (n = 280) with a control group of non-diabetics (n = 996), were enrolled into the study from 2003 to 2005. This cross-sectional study was conducted for all the subjects, using personal data regarding clinical characteristics and lifestyle. Multiple regression analysis was performed to analyze the association of tHcy with selected factors.</p><p><b>RESULTS</b>In diabetic subjects, estimated glomerular filtration rate (eGFR) and serum creatinine levels (Cre), even those within the normal range, were strongly associated with tHcy after adjustment in both sexes; the standardized partial regression coefficient of eGFR for tHcy was -0.251, (p = 0.001) in diabetic men and -0.523, (p < 0.001) in diabetic women. Furthermore, the eGFR of the diabetics, except patients with nephropathy, also had significant association with tHcy in both sexes. Fasting plasma glucose levels and serum triglyceride levels were strongly associated with tHcy in diabetic men only. HbA1c was also associated with tHcy in diabetic men only, though not as significantly. Age and presence of hypertension were significantly associated with tHcy in women.</p><p><b>CONCLUSIONS</b>This study suggests that there are some differences in the factors associated with tHcy between diabetics and non-diabetics, and between the sexes. There is, therefore, circumstantial evidence that elevated tHcy should be evaluated clinically. Because tHcy was strongly associated with eGFR and Cre, even within the normal ranges, tHcy may have important implications regarding the microangiopathy of the kidney and atherosclerosis.</p>

Personal features and dropout from diabetic care

<p><b>OBJECTIVE</b>To investigate the personal features associated with dropout from regular outpatient care among persons with type 2 diabetes mellitus (DM).</p><p><b>METHODS</b>A total of 160 DM patients were enrolled in the study. As a retrospective analysis, outpatient's clinical characteristics, lifestyle, or social features were gathered from their medical records or interview sheets. All the subjects were divided into two groups by adherence to diabetic care, namely, 'dropout case' (DC), or 'ongoing case' (OC), and were subjected to comparative analysis. We called the patients who did not receive outpatient treatment from the clinic on a regular basis, including treatment from other clinics or dropout of diabetic care, as DC. In contrast, patients who regularly visited the clinic were defined as OC. An unconditional multiple logistic regression analysis was performed to analyze the association of a dherence to diabetic care with several personal features.</p><p><b>RESULTS</b>Sixty-eight of 160 subjects (42.5%) were recognized as DC. The remaining 92 subjects (57.5%) were considered as OC. Young age (p=0.045), low plasma glucose (p=0.005) and hemoglobin A1c (HbA1c) levels (p=0.005), nonmedication (p<0.001) and no past history of DM (p=0.007) at the initial visit were the features related to dropout by crude analysis. Even after adjustment for age and gender by multivariate analysis, there remained significant inverse associations of dropout with HbA1c level, medical treatment (oral agents or insulin) and previous DM history. Neither occupation, distance from residence to clinic, smoking habit nor drinking habit was associated with dropout. Dropout mostly occurred after the initial or second visit.</p><p><b>CONCLUSIONS</b>A mild condition of DM may be related to dropout from regular outpatient care. It may be necessary to clearly show the objectives and importance of regular visit to an outpatient clinic for diabetic care, particularly for screened mild DM cases in public health activities.</p>

Personal Features and Dropout from Diabetic Care

Objective: To investigate the personal features associated with dropout from regular outpatient care among persons with type 2 diabetes mellitus (DM). Methods: A total of 160 DM patients were enrolled in the study. As a retrospective analysis, outpatient’s clinical characteristics, lifestyle, or social features were gathered from their medical records or interview sheets. All the subjects were divided into two groups by adherence to diabetic care, namely, ‘dropout case’ (DC) or ‘ongoing case’ (OC), and were subjected to comparative analysis. We called the patients who did not receive outpatient treatment from the clinic on a regular basis, including treatment from other clinics or dropout of diabetic care, as DC. In contrast, patients who regularly visited the clinic were defined as OC. An unconditional multiple logistic regression analysis was performed to analyze the association of adherence to diabetic care with several personal features. Results: Sixty-eight of 160 subjects (42.5%) were recognized as DC. The remaining 92 subjects (57.5%) were considered as OC. Young age (p=0.045), low plasma glucose (p=0.005) and hemoglobin A1c (HbA1c) levels (p=0.005), nonmedication (p<0.001) and no past history of DM (p=0.007) at the initial visit were the features related to dropout by crude analysis. Even after adjustment for age and gender by multivariate analysis, there remained significant inverse associations of dropout with HbA1c level, medical treatment (oral agents or insulin) and previous DM history. Neither occupation, distance from residence to clinic, smoking habit nor drinking habit was associated with dropout. Dropout mostly occurred after the initial or second visit. Conclusions: A mild condition of DM may be related to dropout from regular outpatient care. It may be necessary to clearly show the objectives and importance of regular visit to an outpatient clinic for diabetic care, particularly for screened mild DM cases in public health activities.

Genetic epidemiological studies of longevity-associated mitochondrial DNA 5178 C/A polymorphism

Mitochondrial DNA 5178 cytosine/adenine (Mt5178 C/A) polymorphism is associated with longevity in the Japanese population, and the Mt5178A genotype may confer antiatherogenic advantages. Individuals with the Mt5178A genotype may be more resistant to adult-onset diseases, such as myocardial infarction, cerebrovascular diseases and type 2 diabetes, than those with the Mt5178C genotype. Moreover, Mt5178 C/A polymorphism has been reported to be associated with blood pressure, serum lipid levels, hematological parameters, intraocular pressure, serum protein fraction levels and serum electrolyte levels in healthy Japanese individuals. Differences in the influence of habitual drinking or habitual smoking on health status between the Mt5178C genotype and the Mt5178A genotype have been reported. The individual modification of drinking habits or smoking habits based on the genotyping of Mt5178 C/A may promote improved health and lead to the establishment of personalized prevention strategies for adult-onset diseases.

Genetic Epidemiological Studies of Longevity-Associated Mitochondrial DNA 5178 C/A Polymorphism

Mitochondrial DNA 5178 cytosine/adenine (Mt5178 C/A) polymorphism is associated with longevity in the Japanese population, and the Mt5178A genotype may confer antiatherogenic advantages. Individuals with the Mt5178A genotype may be more resistant to adult-onset diseases, such as myocardial infarction, cerebrovascular diseases and type 2 diabetes, than those with the Mt5178C genotype. Moreover, Mt5178 C/A polymorphism has been reported to be associated with blood pressure, serum lipid levels, hematological parameters, intraocular pressure, serum protein fraction levels and serum electrolyte levels in healthy Japanese individuals. Differences in the influence of habitual drinking or habitual smoking on health status between the Mt5178C genotype and the Mt5178A genotype have been reported. The individual modification of drinking habits or smoking habits based on the genotyping of Mt5178 C/A may promote improved health and lead to the establishment of personalized prevention strategies for adult-onset diseases.

Interrelations among smoking habits, casual blood pressure and intraocular pressure in middle and old-aged Japanese residents

<p><b>OBJECTIVES</b>To investigate the association of smoking habits with blood pressure (BP) and intraocular pressure (IOP), and to examine whether the smoking-BP association is related to the IOP level.</p><p><b>METHODS</b>This study was conducted on the basis of a cross-sectional design using annual health check-up data during one-year between August, 1999 and August, 2000 for 611 middle and old-aged Japanese residents living in Ibaraki prefecture, Japan.</p><p><b>RESULTS</b>After adjustment for age, gender, body mass index and alcohol intake score, the proportion of hypertensives, and the mean systolic and diastolic blood pressure (SBP and DBP) of the subjects without antihypertensive medications were the highest (50.4%, 129.6 mmHg and 75.9 mmHg, respectively) in the "smokers of 25 or more cigarettes per day with intraocular pressure (IOP)≥15 mmHg" of six subgroups crossed by three smoking categories (non-smokers, 1 to 24 cigarettes per day, and 25 or more cigarettes per day) and two IOP categories (less than 15 mmHg, and 15mmHg or greater). On the other hand, the adjusted proportion of hypertensives, and the adjusted mean SBP and DBP decreased with increasing smoking category in the individuals with less than 15 mmHg of the IOP (p for trend=0.028 for proportion of hypertensives 0.008 for the SBP, and 0.001 for the DBP, respectively).</p><p><b>CONCLUSIONS</b>Heavy smoking may be specifically related to 'high BP accompanied by high IOP', although the BP may be inversely associated with smoking under the condition without high IOP.</p>

Interrelations among Smoking Habits, Casual Blood Pressure and Intraocular Pressure in Middle and Old-Aged Japanese Residents

Objectives: To investigate the association of smoking habits with blood pressure (BP) and intraocular pressure (IOP), and to examine whether the smoking-BP association is related to the IOP level. Methods: This study was conducted on the basis of a cross-sectional design using annual health check-up data during one-year between August, 1999 and August, 2000 for 611 middle and old-aged Japanese residents living in Ibaraki prefecture, Japan. Results: After adjustment for age, gender, body mass index and alcohol intake score, the proportion of hypertensives, and the mean systolic and diastolic blood pressure (SBP and DBP) of the subjects without antihypertensive medications were the highest (50.4%, 129.6 mmHg and 75.9 mmHg, respectively) in the “smokers of 25 or more cigarettes per day with intraocular pressure (IOP) >15 mmHg” of six subgroups crossed by three smoking categories (non-smokers, 1 to 24 cigarettes per day, and 25 or more cigarettes per day) and two IOP categories (less than 15 mmHg, and 15 mmHg or greater). On the other hand, the adjusted proportion of hypertensives, and the adjusted mean SBP and DBP decreased with increasing smoking category in the individuals with less than 15 mmHg of the IOP (p for trend=0.028 for proportion of hypertensives, 0.008 for the SBP, and 0.001 for the DBP, respectively). Conclusions: Heavy smoking may be specifically related to ‘high BP accompanied by high IOP’, although the BP may be inversely associated with smoking under the condition without high IOP.