Annals of Occupational and Environmental Medicine

Original Article

The effect of long working hours on developing type 2 diabetes in adults with prediabetes: The Kangbuk Samsung Cohort Study: Eunhye Seo, Yesung Lee, Eunchan Mun, Dae Hoon Kim, Youshik Jeong, Jaehong Lee, Jinsook Jeong, Woncheol Lee; Ann Occup Environ Med 2022;34:e4. Published online March 14, 2022; DOI: https://doi.org/10.35371/aoem.2022.34.e4

Abstract Abstract in Korean PDF Supplementary Material PubReader ePub

Background

Long working hours are known to account for approximately one-third of the total expected work-related diseases, and much interest and research on long working hours have recently been conducted. Additionally, as the prevalence of prediabetes and the high-risk group for diabetes are increasing worldwide, interest in prediabetes is also rising. However, few studies have addressed the development of type 2 diabetes and long working hours in prediabetes. Therefore, the aim of this longitudinal study was to evaluate the relationship between long working hours and the development of diabetes in prediabetes.

Methods

We included 14,258 prediabetes participants with hemoglobinA1c (HbA1c) level of 5.7 to 6.4 in the Kangbuk Samsung Cohort Study. According to a self-reported questionnaire, we evaluated weekly working hours, which were categorized into 35–40, 41–52, and > 52 hours. Development of diabetes was defined as an HbA1c level ≥ 6.5%. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the development of diabetes were estimated using Cox proportional hazards analyses with weekly working 35–40 hours as the reference.

Results

During a median follow-up of 3.0 years, 776 participants developed diabetes (incidence density, 1.66 per 100 person-years). Multivariable-adjusted HRs of development of diabetes for weekly working > 52 hours compared with working 35–40 hours were 2.00 (95% CI: 1.50–2.67). In subgroup analyses by age (< 40 years old, ≥ 40 years old), sex (men, women), and household income (< 6 million KRW, ≥ 6 million KRW), consistent and significant positive associations were observed in all groups.

Conclusions

In our large-scale longitudinal study, long working hours increases the risk of developing diabetes in prediabetes patients.

당뇨전단계 성인의 제 2형 당뇨로 진행에 대한 장시간 근무의 영향: 강북삼성 코호트 연구
목적
이 연구의 목적은 당뇨전단계라는 고위험그룹에서 장시간 노동과 당뇨로의 진행 사이의 관계를 종단적 연구로 평가하는 것이다.
방법
연구는 강북 삼성 종합 건진 센터에서 2012년 1월 1일부터 2018년 12월 31 일 사이에 최소 두번의 건강검진을 받은 수검자 중, HbA1c 수치가 5.7~6.4인 당뇨전단계 기준을 만족하는 14,258명을 포함했다. 참가자들은 자체 보고된 설문지를 사용하여 3개 그룹 (35-40시간, 41-52시간 및 >52시간)으로 나뉘었고 당뇨로의 진행은 HbA1c 수치 ≥6.5%로 정의되었다. 당뇨 발병에 대한 위험 비율(HR) 및 95% 신뢰 구간(CI)은 주당 35-40시간 근무하는 그룹을 기준으로 Cox 비례 위험 분석을 사용하여 추정되었다.
결과
중앙값 3.0년의 추적 기간 동안 776명의 참가자가 당뇨(발병률, 100인년당 1.66)로 발전했습니다. 주당 근무시간이 35-40시간인 그룹과 비교하여 52시간 초과 근무한 그룹의 다 변수 조정 당뇨 발생 위험비율은 2.00(95% 신뢰구간 [1.50–2.67])이었다. 연령(40세 미만, 40세 이상), 성별(남성, 여성) 및 가계 소득(600만원, 600만원)에 따른 하위 그룹 분석에서 모든 그룹에서 일관되고 유의한 연관성이 관찰되었다.
결론
이 대규모 종단 연구는 당뇨전단계에서 긴 근무 시간이 당뇨 발병과 관련이 있음을 보여주었다.

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Research Article

Relationship between urinary phthalate metabolites and diabetes: Korean National Environmental Health Survey (KoNEHS) cycle 3 (2015–2017): Do Jin Nam, Yeji Kim, Eun Hye Yang, Hyo Choon Lee, Jae-Hong Ryoo; Ann Occup Environ Med 2020;32:e34. Published online September 18, 2020; DOI: https://doi.org/10.35371/aoem.2020.32.e34

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Background

We aimed to determine relationship diabetes according to urinary phthalate metabolites using adult data from Korean National Environmental Health Survey cycle 3 (2015–2017).

Method

This study was conducted on 3,781 adults aged 19 years and older (1,648 men and 2,133 women) based on KoNEHS cycle 3. Participants' data were analyzed by gender; Relationship between phthalate metabolites in the urine and diabetes was analyzed by dividing the sociodemographic variables, health behavior-related variables, and urinary phthalate metabolite concentrations into quartiles. To determine the relationship between urinary phthalate metabolites and the prevalence of diabetes, the odds ratio (OR) was calculated using logistic regression analysis.

Results

Based on the 1st quartile of each metabolite, the ORs for di-2-ethylhexyl phthalate (DEHP) (4th quartile), mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) (2nd quartile, 3rd quartile and 4th quartile), mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP) (4th quartile), mono-(2-ethyl-5-carboxypentyl) phthalate (MECCP) (4th quartile), mono-n-butyl phthalate (MnBP) (3rd quartile and 4th quartile), mono-benzyl phthalate (MBzP) (2nd quartile) and 4th quartile), and mono (3-carboxypropyl) phthalate (MCPP) (3rd quartile and 4th quartile) were significantly higher after the adjustment in men. The ORs for DEHP (2nd quartile, 3rd quartile and 4th quartile), MEHHP (2nd quartile, 3rd quartile and 4th quartile), MEOHP (4th quartile), MECCP (4th quartile), MBzP (4th quartile), and MCPP (4th quartile) were significantly higher after the adjustment in women.

Conclusion

This study investigated relationship between urinary phthalate metabolites and diabetes. The higher urinary phthalate metabolites, the higher the prevalence of diabetes. Further regulation of phthalate may be needed, and further studies are warranted to confirm the association between phthalate concentration and other chronic diseases (such as hypertension, hyperlipidemia, and cardiovascular disease).

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Research Article

Effect of night shift work on the control of hypertension and diabetes in workers taking medication: Juha Park, Sang-Yeop Shin, Yangwon Kang, Jeongbae Rhie; Ann Occup Environ Med 2019;31:e27. Published online October 10, 2019; DOI: https://doi.org/10.35371/aoem.2019.31.e27

Abstract PDF PubReader ePub

Background

Night shift work induces physiological and psychological stress by altering sleep and biological rhythms and is associated with hypertension, diabetes, obesity, and cardiovascular diseases. Few studies have been conducted on the control of hypertension and diabetes. This study aimed to examine the effect of night shift work on the control rate of hypertension and diabetes.

Methods

Subjects comprised workers aged 20–65 years who underwent specific health examination at a single facility in seven different affiliated examination centers from 1 January to 31 December 2016. Workers were categorised into day workers and night shift workers. Demographic and medical history were taken, and physical examination was done. Blood pressure (BP) and fasting glucose were measured. The control rate of each disease was evaluated based on treatment goals presented in the treatment guidelines of the Korean Society of Hypertension and the Korean Diabetes Association (systolic BP < 140 mmHg and diastolic BP < 90 mmHg; fasting glucose ≤ 130 mg/dL).

Results

Among 631,418 subjects, 11.2% (70,450) were night shift workers. Of whom 6.1% (4,319) were taking antihypertensive medication and 2.5% (1,775) were taking diabetes medication. Among patients taking antihypertensive medications, the proportion of those whose BP was controlled to suit treatment goals was 81.7% (26,635) of day workers and 77.4% (3,343) of night shift workers, which was significantly different (p < 0.001). Among patients taking diabetes medications, the proportion of those whose blood glucose was controlled to suit treatment goals was 37.4% (4,489) of day workers and 36.5% (647) of night shift workers, but the difference was not significant. The control rates for patients taking antihypertensive medications (odds ratio [OR]: 0.74, 95% confidence interval [CI]: 0.68–0.80) were lower among night shift workers than day workers with adjustment for age, sex, smoking history, alcohol consumption, exercise, and obesity. However, there were no differences in control rates for patients taking diabetes medications (OR: 0.99, 95% CI: 0.87–1.10) between day workers and night shift workers.

Conclusions

Night shift work can have an effect on the uncontrolled BP in workers taking antihypertensive medications. Therefore, additional efforts for disease control are necessary for night shift workers with hypertension.

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Research Article

The effect of diabetes on 4-year changes of hearing thresholds in male workers exposed to noise in a single company: a longitudinal study: Dae Yun Kim, A Ram Kim, Joo Hyun Sung, Choong Ryeol Lee, Jiho Lee; Ann Occup Environ Med 2019;31:e11. Published online June 28, 2019; DOI: https://doi.org/10.35371/aoem.2019.31.e11

Abstract PDF PubReader ePub: Background
Recently, several studies have assessed the association between diabetes and hearing impairment. However, the effect of diabetes on hearing impairment is not well known in diabetic patients exposed to noise, a typical cause of hearing impairment. The aim of this study is to longitudinally analyze the effect of diabetes on hearing impairment in workers exposed to similar noise levels from 2013 to 2017 who had experienced little change in their working conditions.
Methods
The study subjects included 2,087 male workers exposed to noise in a single company and who underwent health examinations at the same hospital in Ulsan city in 2013 and 2017. Hearing impairment was defined that a pure-tone average of pure-tone audiometry (PTA) thresholds at 1,000, 2,000, 3,000, and 4,000 Hz was 25 dB and over in both ears. Statistical analyses were conducted using χ² tests, ANOVA, and Cox proportional hazard models. We analyzed covariates that might affect hearing impairment, including age; working period; levels of total cholesterol, triglyceride, and serum creatinine; smoking and alcohol history; and noise level.
Results
The average PTA thresholds and their average changes between 2013 and 2017 were significant in the diabetes mellitus (DM) group than those in the normal and impaired fasting glucose group. Among the subjects with the same status of fasting glucose group in 2013 and 2017, the adjusted hazard ratios for incident hearing impairment among those in the DM group compared to normal group were 3.35 (95% confidence interval [CI], 1.54–7.29) in the left ear and 5.66 (95% CI, 2.01–15.98) in the right ear.
Conclusions
This study suggested that the risk of hearing impairment in the DM group was significantly higher than that in the normal group in both ears, even when exposed to similar noise levels.

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Research Article

Risks of borderline liver enzyme abnormalities to the incidence of impaired fasting glucose and diabetes mellitus: a 7 year follow up study of workers: Jin-Hyun Yu, Jin-Seok Kim, Mee-Ra Lee, Seong-Yong Yoon, Seong-Yong Cho, Seung-Hyun Yoo, Boo-Il Kim; Ann Occup Environ Med 2016;28:18. Published online April 7, 2016; DOI: https://doi.org/10.1186/s40557-016-0105-4

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Background

The aim of this study was to identify the relationships between borderline serum liver enzyme abnormalities and the incidence of impaired fasting glucose (IFG) and diabetes mellitus (DM) during a 7-year follow-up of workers, and to evaluate the quantitative level of risks.

Methods

A total of 749 workers in an electronics manufacturing company were divided into the normal fasting blood glucose (n = 633), IFG (n = 98), and DM (n = 18) groups, according to the results of their health checkup in 2006. Among 633 workers in the normal group, excluding 55 workers who were impossible to follow, incidence rate and relative risks of 578 workers to the IFG or DM in 2013 according to the levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyltransferase (γ-GTP) were investigated. The liver enzyme levels were categorized as A (normal), B (borderline elevation), and R (definite elevation) following the standard of the National Health Insurance Service of Korea.

Results

The incidence rate of IFG or DM based on ALT level was 9.7 % for the A, 30.0 % for B, and 15.4 % for R. According to γ-GTP, the incidence rate was 9.8 % for A, 34.5 % for B, and 25.0 % for R. The relative risk(RR) to the incidence of IFG or DM depending on the level of ALT were 3.09 in B and 1.59 in R compared to A. According to γ-GTP, RR was 3.52 in B and 2.55 in R compared to A. AST level was not related to the incidence of IFG or DM. A multiple logistic regression analysis with the incidence of IFG or DM as a dependent variable resulted in an odds ratio of 2.664(1.214–5.849) for B level ALT, 3.685(1.405–9.667) for B level of γ-GTP even after adjustment for other variables such as age, sex, body mass index, AUDIT score, systolic blood pressure, and triglyceride.

Conclusions

Even borderline elevations of ALT and γ-GTP, but not AST, increased the incidence and risk of IFG or DM after 7 years. Borderline elevation of ALT and γ-GTP was identified as an independent risk factor of IFG or DM.

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