Assessing and targeting key lifestyle cardiovascular risk factors at the workplace: Effect on hemoglobin A1c levels

<div><p></p><p><b>Purpose</b> Despite the key role played by lifestyle habits in the epidemic of type 2 diabetes (T2D), nutritional quality and physical activity are not systematically considered in clinical practice. The project was conducted to verify whether assessing/targeting lifestyle habits could reduce hemoglobin A1c (HbA1c) levels of employees. <b>Methods</b> The intervention consisted of a 3-month competition among teams of five employees to favor peer-based support in the adoption of healthier lifestyle habits (Eat better, Move more, and Quit smoking) (n = 900). A comprehensive cardiometabolic/cardiorespiratory health assessment was conducted before and after the contest (nutrition/physical activity questionnaires, blood pressure, anthropometric measurements, lipid profile, HbA1c, fitness). HbA1c levels were used to identify individuals with prediabetes (5.7%–6.4%) or T2D (≥6.5%). <b>Results</b> At baseline, 51% of the employees had increased HbA1c levels (≥5.7%). The HbA1c levels were associated with waist circumference, independently of body mass index. Subjects with prediabetes showed a higher waist circumference as well as a more deteriorated cardiometabolic profile compared to workers with normal HbA1c levels. After the intervention, employees with elevated HbA1c significantly reduced their HbA1c levels. <b>Conclusion</b> Results suggest that assessing/targeting key lifestyle correlates of the cardiometabolic profile represents a relevant approach to target abdominal obesity and fitness with a significant impact on HbA1c levels. </p><p></p><p>Key Messages</p><p></p><p>The prevalence of employees with prediabetes or undiagnosed type 2 diabetes (T2D) was rather high in our cohort, suggesting that, from a public health standpoint, identification of those individuals is not optimal.</p><p></p><p></p><p>Employees with prediabetes or T2D showed a higher waist circumference and a more deteriorated cardiometabolic risk profile compared to those with normal HbA1c levels.</p><p></p><p></p><p>The significant reduction in HbA1c levels observed in response to the 3-month intervention supports the notion that a program which assesses and manages cardiometabolic risk at the workplace by also focusing on key lifestyle factors (nutritional quality and physical activity levels) represents an interesting option to reduce the risk of developing diabetes among high-risk individuals or to improve glycemic control and related cardiometabolic risk in patients with T2D.</p><p></p><p></p><p></p></div

Proportion of participants in each sleep duration category who meet criteria for the metabolic syndrome.¹

1<p>Metabolic syndrome defined according to the American Heart Association/National Heart, Lung, and Blood Institute’s criteria (AHA/NHLBI) as the presence of three or more of the following: (1) waist circumference greater than 102 cm in men or greater than 88 cm in women; (2) fasting serum glucose of 5.6 mmol/L or greater, or use of oral hypoglycemic medication; (3) blood pressure of 130 mm Hg systolic, 85 mm Hg diastolic or higher, or use of antihypertensive medication; (4) serum triglycerides of 1.7 mmol/L or higher, or medication for hypertriglyceridemia; and (5) high-density lipoprotein (HDL) cholesterol of less than 1.03 mmol/L in men or 1.29 mmol/L in women, or use of medication for low HDL cholesterol.</p><p>Abbreviations: HDL, high-density lipoprotein. Data are presented as percentage. Statistical significance was assessed by a chi-squared test.</p><p>A post-hoc test was used to contrast differences between sleep duration groups. *Significantly different from the 7–8 h sleep group.</p>†<p>Significantly different from the ≥9 h sleep group.</p

Clustered cardiometabolic risk score between sleep duration groups.

<p><i>Legend:</i> Data are presented as mean values with standard errors of the mean. Clustered cardiometabolic risk scores between sleep duration categories were compared by analysis of covariance, followed by a Tukey post-hoc test to contrast mean differences. The model was adjusted for age, sex, smoking habits, highest education level, total annual family income, alcohol consumption, coffee intake, menopausal status, daily caloric intake, and moderate-to-vigorous physical activity as covariates. <i>P</i><0.05 for the ANOVA analysis. *<i>P</i><0.05 vs. adequate sleepers. Short sleepers (≤6 h of sleep per night; <i>n</i> = 90), adequate sleepers (7–8 h of sleep per night; <i>n</i> = 571), and long sleepers (≥9 h of sleep per night; <i>n</i> = 149).</p

Baseline characteristics of participants according to sleep duration group.

<p>Abbreviations: HDL, high-density lipoprotein; MVPA, moderate-to-vigorous physical activity. Values are mean ± SD or <i>n</i> (%).</p><p>Statistical significance was assessed by analysis of variance with continuous variables and by a chi-squared test with categorical variables. A Tukey post-hoc test was used to contrast mean differences. *Significantly different from the 7–8 h sleep group. †Significantly different from the ≥9 h sleep group.</p

Baseline subject characteristics across tertiles of baseline sedentary behaviour in males.

<p>Data are expressed as mean (SD) unless otherwise specified.</p><p>L = low sedentary behaviour at baseline; M = medium sedentary behaviour at baseline; H = high sedentary behaviour at baseline; MVPA, moderate-to-vigorous physical activity; BMI, body mass index; AT, adipose tissue; HOMA-IR, homeostasis model assessment of insulin resistance; AUC, area under-the-curve.</p>*<p>In Québec, there is a level of education generally lasting 2 to 3 years between high school and university termed CEGEP (<i>Collège d'Enseignement Général et Professionnel</i>), an acronym that does not have any translation in English.</p

Associations (95% confidence interval) of baseline sedentary behaviour with 6-year change in markers of adiposity.

<p>Model 1: unadjusted.</p><p>Model 2: adjusted for age and sex.</p><p>Model 3: adjusted for age, sex, baseline BMI, energy intake, moderate-to-vigorous physical activity, educational level, income, smoking and menopausal status.</p>*<p><i>p</i><0.05.</p><p>M, Male; F, Female; BMI, Body Mass Index; WC, Waist Circumference; Fat%, body fat percentage; TAAT, total abdominal adipose tissue; VAT, visceral adipose tissue; ASAT, abdominal subcutaneous adipose tissue.</p

Associations (95% confidence interval) of sedentary behaviour and markers of cardiometabolic risk at baseline.

<p>Model 1: unadjusted.</p><p>Model 2: adjusted for age and sex.</p><p>Model 3: adjusted for age, sex, BMI, energy intake, moderate-to-vigorous physical activity, educational level, income, smoking and menopausal status.</p>*<p><i>p</i><0.05.</p><p>M, Male; F, Female; HDL-C, HDL-Cholesterol; LDL-C, LDL-Cholesterol; TG, triglycerides; FG, fasting glucose; FI, fasting insulin; AUC, area under-the-curve.</p

Associations (95% confidence interval) of baseline sedentary behaviour with 6-year change in markers of cardiometabolic risk.

<p>Model 1: unadjusted.</p><p>Model 2: adjusted for age and sex.</p><p>Model 3: adjusted for age, sex, baseline BMI, energy intake, moderate-to-vigorous physical activity, educational level, income, smoking and menopausal status.</p>*<p><i>p</i><0.05.</p><p>M, Male; F, Female; HDL-C, HDL-Cholesterol; LDL-C, LDL-Cholesterol; TG, triglycerides; FG, fasting glucose; FI, fasting insulin; AUC, area under-the-curve.</p

Associations (95% confidence interval) of sedentary behaviour and markers of adiposity at baseline.

<p>Model 1: unadjusted.</p><p>Model 2: adjusted for age and sex.</p><p>Model 3: adjusted for age, sex, BMI, energy intake, moderate-to-vigorous physical activity, educational level, income, smoking and menopausal status.</p>*<p><i>p</i><0.05.</p><p>M, Male; F, Female; BMI, Body Mass Index; WC, Waist Circumference; Fat%, body fat percentage; TAAT, total abdominal adipose tissue; VAT, visceral adipose tissue; ASAT, abdominal subcutaneous adipose tissue.</p

Baseline subject characteristics across tertiles of baseline sedentary behaviour in females.

<p>Data are expressed as mean (SD) unless otherwise specified.</p><p>L = low sedentary behaviour at baseline; M = medium sedentary behaviour at baseline; H = high sedentary behaviour at baseline; MVPA, moderate-to-vigorous physical activity; BMI, body mass index; AT, adipose tissue; HOMA-IR, homeostasis model assessment of insulin resistance; AUC, area under-the-curve.</p>*<p>In Québec, there is a level of education generally lasting 2 to 3 years between high school and university termed CEGEP (<i>Collège d'Enseignement Général et Professionnel</i>), an acronym that does not have any translation in English.</p