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Abstract
Background
Environmental and lifestyle changes, in addition to the ageing of populations, are
generally believed to account for the rapid global increase in type 2 diabetes prevalence
and incidence in recent decades.
Discussion
In this review, we present a comprehensive overview of factors contributing to diabetes
risk, including aspects of diet quality and quantity, little physical activity, increased
monitor viewing time or sitting in general, exposure to noise or fine dust, short
or disturbed sleep, smoking, stress and depression, and a low socioeconomic status.
In general, these factors promote an increase in body mass index. Since loss of β-cell
function is the ultimate cause of developing overt type 2 diabetes, environmental
and lifestyle changes must have resulted in a higher risk of β-cell damage in those
at genetic risk. Multiple mechanistic pathways may come into play.
Conclusions
Strategies of diabetes prevention should aim at promoting a ‘diabetes-protective lifestyle’
whilst simultaneously enhancing the resistance of the human organism to pro-diabetic
environmental and lifestyle factors. More research on diabetes-protective mechanisms
seems warranted.
Observational studies have suggested an association between active smoking and the incidence of type 2 diabetes. To conduct a systematic review with meta-analysis of studies assessing the association between active smoking and incidence of type 2 diabetes. A search of MEDLINE (1966 to May 2007) and EMBASE (1980 to May 2007) databases was supplemented by manual searches of bibliographies of key retrieved articles, reviews of abstracts from scientific meetings, and contact with experts. Studies were included if they reported risk of impaired fasting glucose, impaired glucose tolerance, or type 2 diabetes in relationship to smoking status at baseline; had a cohort design; and excluded persons with diabetes at baseline. Two authors independently extracted the data, including the presence or absence of active smoking at baseline, the risk of diabetes, methods used to detect diabetes, and key criteria of study quality. Relative risks (RRs) were pooled using a random-effects model. Associations were tested in subgroups representing different patient characteristics and study quality criteria. The search yielded 25 prospective cohort studies (N = 1.2 million participants) that reported 45 844 incident cases of diabetes during a study follow-up period ranging from 5 to 30 years. Of the 25 studies, 24 reported adjusted RRs greater than 1 (range for all studies, 0.82-3.74). The pooled adjusted RR was 1.44 (95% confidence interval [CI], 1.31-1.58). Results were consistent and statistically significant in all subgroups. The risk of diabetes was greater for heavy smokers (> or =20 cigarettes/day; RR, 1.61; 95% CI, 1.43-1.80) than for lighter smokers (RR,1.29; 95% CI, 1.13-1.48) and lower for former smokers (RR, 1.23; 95% CI, 1.14-1.33) compared with active smokers, consistent with a dose-response phenomenon. Active smoking is associated with an increased risk of type 2 diabetes. Future research should attempt to establish whether this association is causal and to clarify its mechanisms.
There is an epidemic of diabetes in Asia. Type 2 diabetes develops in East Asian patients at a lower mean body mass index (BMI) compared with those of European descent. At any given BMI, East Asians have a greater amount of body fat and a tendency to visceral adiposity. In Asian patients, diabetes develops at a younger age and is characterized by early β cell dysfunction in the setting of insulin resistance, with many requiring early insulin treatment. The increasing proportion of young-onset and childhood type 2 diabetes is posing a particular threat, with these patients being at increased risk of developing diabetic complications. East Asian patients with type 2 diabetes have a higher risk of developing renal complications than Europeans and, with regard to cardiovascular complications, a predisposition for developing strokes. In addition to cardiovascular–renal disease, cancer is emerging as the other main cause of mortality. While more research is needed to explain these interethnic differences, urgent and concerted actions are needed to raise awareness, facilitate early diagnosis, and encourage preventive strategies to combat these growing disease burdens.
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History
Date
received
: 14
March
2017
Date
accepted
: 23
June
2017
Funding
Funded by: Gesellschaft von Freunden und Förderern der Heinrich-Heine-Universität Düsseldorf
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