[논문]당뇨병전기 성인의 신체운동과 류마티스 발생률

신혜연

doi:10.24304/kjcp.2019.29.4.278

당뇨병전기 성인의 신체운동과 류마티스 발생률
Physical Activity and Prevalence of Rheumatoid Arthritis in Korean Adults with Prediabetes in the 2009-2013 National Health Cohort Study 원문보기

한국임상약학회지 = Korean journal of clinical pharmacy, v.29 no.4, 2019년, pp.278 - 285

Abstract ▼ AI-Helper

Background: Rheumatoid arthritis is highly prevalent in overweight patients with type 2 diabetes mellitus and can be reduced by physical activity via altered proinflammatory parameters. However, the association between the frequency of physical activity and the prevalence of rheumatoid arthritis in prediabetic patients remains unclear and was evaluated in this study. Methods: Utilizing the Korean National Health Insurance Sharing Service database, 58,391 adults, who met the research criteria and underwent a general medical check-up between 2009 and 2013, were selected for this study. To analyze the data, a logistic regression with a proc survey logistic procedure was used. Results: The study revealed that the cumulative rheumatoid arthritis prevalence was lower in prediabetic patients compared to that in the control group (OR, 0.64; 95% CI, 0.483-0.840; p=0.001). More frequent physical activity (≥3 days/week) was significantly associated with a reduced rheumatoid arthritis prevalence in both groups (OR, 0.28; 95% CI, 0.039-0.521; p=0.044 vs. OR, 0.15; 95% CI, 0.063-0.237; p=0.007). Additionally, a 3.8-fold higher risk of rheumatoid arthritis development was observed in prediabetic adults with less frequent baseline physical activity (≤2 days/week). Overall, in prediabetes, the prevalence of rheumatoid arthritis was associated with the frequency of physical activity and not with the fasting plasma glucose levels. Conclusion: More frequent physical activity is associated with a low risk of developing rheumatoid arthritis in prediabetic patients. Thus, further studies are needed to confirm the clinical outcomes of frequent physical activity in rheumatoid arthritis prevention and control.

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문제 정의

The author is grateful to Dr. Junsung Kang, from the department of Informational Statistics in Gang Neung-Wnoju National University, for his support in statistical analyses.
study⁴²⁾ surveyed only a major chronic disease associated with musculoskeletal diseases, individually interviewing different household members; however, patients with sub-sicknesses of musculoskeletal disease seem to be omitted from the subjects, making it difficult for the results to reflect the exact number of RA patients. Therefore, during studies, it is necessary to estimate RA prevalence by stratification of homogeneous populations. To avoid selection bias, omission bias, and interviewer bias, the present study included both mainsickness and sub-sickness codes for RA, excluded diabetic patients, and confirmed RA status in prediabetic Korean patients.

제안 방법

Additionally, to evaluate RA prevalence based on physical activity level, subjects were divided into two subgroups: those who had physical activity ≥3 times/week for at least 20-30 min/day and those who had physical activity ≤2 times a week.
Despite these limitations, this study supports the association that RA prevalence is lower in prediabetic adults with more frequent physical activity, compared with those with less frequent physical activity, and that lack of physical activity causes chronic diseases^,39) including diabetes, RA, and prediabetes.
Physical activity, which was defined as follows: walking for at least 30 min/day, lightly bicycling for at least 30 min/day, and jogging or aerobics for at least 20 min/day was assessed using a simple measurement number in the survey questionnaire, which was sub-classified into eight numbers based on the frequency of the three activity types. The eight numbers indicated the frequency of each physical activity type/week.
Based on stratified, clustered, and systematic sampling, Primary outcome of unadjusted RA prevalence was evaluated using a proc logistic procedure and a proc freq procedure; a logistic regression model was used for p values. Secondary outcome of risk of cumulative RA prevalence with regard to physical activity frequency was evaluated using a proc univariate procedure for mean and SD and a logistic regression for p value. Using logistic regression with a proc logistic procedure, the adjusted odds ratio of RA with regard to variables, including age, FPG, BMI, TG, LDL-C, and past medical history and family history, was performed to estimate potential confounding variables.
Firstly, all the data regarding frequency of physical activity, in relation to RA outcomes, were derived from large population-based survey cohort data, and frequency of physical activity was estimated using a simple frequency measurement number in the survey questionnaire Additionally, the collected physical activity data can be used to identify the exact frequency of physical activity and number of individuals involved. The additional benefits of using this survey questionnaire were that it minimized measurement error and the cost associated with collecting clinical data. However, it also had some limitations.
To assess patient’s baseline characteristics, continuous variables were analyzed using a proc univariate procedure and reported as mean (SD), whereas categorical variables were analyzed using proc survey freq and proc logistic procedures and reported as percentages.
Secondary outcome of risk of cumulative RA prevalence with regard to physical activity frequency was evaluated using a proc univariate procedure for mean and SD and a logistic regression for p value. Using logistic regression with a proc logistic procedure, the adjusted odds ratio of RA with regard to variables, including age, FPG, BMI, TG, LDL-C, and past medical history and family history, was performed to estimate potential confounding variables. A p-value <0.
The data from the cohort database (DB) provided by KNISS included: individual qualification criteria DB, medical treatment DB, and health examination DB. With non-personally identifiable information only used for research, subjects were selected based on a table that was created using the database link, with person identification as a joint key according to the KNISS algorithm. Korean Classification of Disease (KCD) codes were used to identify the main sickness and sub sickness that were diagnosed by physicians.

대상 데이터

This study retrospectively evaluated a cohort of 264,978 adults, aged 50 to 79 years, using their medical records extracted from the centralized database of the Korean National Health Insurance Sharing Service (KNISS). Adults who met the research criteria and visited health institutions for general medical examination at least biannually in the regional areas of South Korea between January 01, 2009, and December 31, 2013, were included. Whereas subjects who were diagnosed with T1DM or T2DM, those no longer under follow-up, and those who had only one laboratory data parameter for FPG and self-questionnaire item for physical activity at baseline and during the biannual visits over the 5-year follow-up period were excluded.
The baseline characteristics of prediabetic patients and patients without impaired fasting plasma glucose (IFG) were compared (Table 1). Of the 264,978 subjects in the KNISS database, 58,391 subjects were included and evaluated retrospectively. A total of 19,204 individuals were confirmed to have prediabetes, whereas 39,186 individuals were confirmed to be without IFG (control group).
This study retrospectively evaluated a cohort of 264,978 adults, aged 50 to 79 years, using their medical records extracted from the centralized database of the Korean National Health Insurance Sharing Service (KNISS). Adults who met the research criteria and visited health institutions for general medical examination at least biannually in the regional areas of South Korea between January 01, 2009, and December 31, 2013, were included.

데이터처리

To assess patient’s baseline characteristics, continuous variables were analyzed using a proc univariate procedure and reported as mean (SD), whereas categorical variables were analyzed using proc survey freq and proc logistic procedures and reported as percentages. Based on stratified, clustered, and systematic sampling, Primary outcome of unadjusted RA prevalence was evaluated using a proc logistic procedure and a proc freq procedure; a logistic regression model was used for p values. Secondary outcome of risk of cumulative RA prevalence with regard to physical activity frequency was evaluated using a proc univariate procedure for mean and SD and a logistic regression for p value.

성능/효과

Overall, RA prevalence among Korean adults, according to the KNISS database, varied with frequency of physical activity. After adjusting for BMI, and TG and LDL-C levels and past medical history, family history, and less frequent physical activity, the analysis showed that less frequent physical activity, hypertriglyceridemia, overweight/obesity, and family history of heart disease were associated with increased risk of RA in prediabetes, only the association of less frequent physical activity was significant (Table 5).
Additionally, to evaluate RA prevalence based on physical activity level, subjects were divided into two subgroups: those who had physical activity ≥3 times/week for at least 20-30 min/day and those who had physical activity ≤2 times a week. In this study, the indicated RA prevalence was cumulative, given that it was difficult to distinguish new RA incidence in a particular year from the duplicated RA record that would appear in the following year in the KNISS.
RA prevalence was 66 (0.34%) (OR, 0.64; 95% CI, 0.483-0.840; p=0.⁰⁰¹⁾ in the prediabetes group and 211 (0.54%) in the control group, indicating that the risk of RA development was not associated with FPG level (Table 2).
The results showed that more frequent physical activity (≥3 days/week, ≥20-30 min/day) had a positive effect on cumulative RA prevalence in both the prediabetes (0.07%) and control (0.07%) groups (OR, 1.00; 95% CI, 0.561-2.064; p=0.825).
The results showed that the cumulative prevalence of RA was significantly lower in prediabetic subjects with frequent physical activity (≥3 days/ week).

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