title: The association of lifestyle and stress with poor glycemic control in patients with diabetes mellitus type 2: a Croatian nationwide primary care cross-sectional study.
abstract: OBJECTIVE
  To assess lifestyle habits and self-reported stress levels among type 2 diabetes mellitus (T2DM) patients and their association with hemoglobin A1c (HbA1c) in general practitioners' (GP) offices in Croatia.
  
  
  METHODS
  449 GPs from all Croatian regions from 2008 to 2010 consecutively recruited up to 20-25 participants diagnosed with T2DM at least 3 years prior to the study, aged ≥40 years, and scheduled for diabetes control check-ups. The recruitment period lasted six months. Lifestyle habits and self-reported stress were assessed using the questionnaire from the Croatian Adult Health Survey.
  
  
  RESULTS
  The study included 10285 patients with T2DM with mean (±standard deviation) age of 65.7±10.05 years (48.1% men). Mean HbA1c level was 7.57±1.58%. 79% of participants reported insufficient physical activity, 24% reported inappropriate dietary patterns, 56% reported current alcohol consumption, 19% were current smokers, and 85% reported at least medium level of stress. Multivariate analysis showed that having received advice to stop drinking alcohol, inadequate physical activity, consumption of milk and dairy products, adding extra salt, and high level of stress were significantly associated with increased HbA1c (P < 0.05).
  
  
  CONCLUSIONS
  Poor glycemic control was more frequent in patients who had several "unhealthy" lifestyle habits. These results suggest that diabetes patients in Croatia require more specific recommendations on diet, smoking cessation, exercise, and stress control.
authors: Valerija Bralić Lang, Private General Practitioner's Office affiliated to University of Zagreb, School of Medicine, Zvonigradska 9, 10000 Zagreb, Croatia, valerija.bralic.lang@gmail.com.
authors: Valerija
authors: V
authors: Bralić Lang
authors: Biserka
authors: B
authors: Bergman Marković
authors: Davorka
authors: D
authors: Vrdoljak
mesh_terms: D000368:Aged; D000428:Alcohol Drinking / Q000503:physiopathology; D017523:Croatia; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000503:physiopathology; D004032:Diet; D015444:Exercise / Q000502:physiology; D005247:Feeding Behavior; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D038321:Glycemic Index; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D013315:Stress, Psychological / Q000097:blood* / Q000503:physiopathology; D011795:Surveys and Questionnaires
chemical_list: D006442:Glycated Hemoglobin