{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T12:10:34Z","timestamp":1770898234517,"version":"3.50.1"},"reference-count":53,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2018,11,28]],"date-time":"2018-11-28T00:00:00Z","timestamp":1543363200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001871","name":"Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia","doi-asserted-by":"publisher","award":["UID\/IC\/4255\/2013"],"award-info":[{"award-number":["UID\/IC\/4255\/2013"]}],"id":[{"id":"10.13039\/501100001871","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Little is known about how working adults with type 2 diabetes are managing their health. This study aims to analyze the associations between health, behavioral, and sociodemographic characteristics and obesity in older diabetic patients in Europe. Data from the Survey of Health, Ageing, and Retirement in Europe was used to compare 1447 participants that were identified as having type 2 diabetes with 28,047 participants without diabetes. Multilevel logistic models stratified by type 2 diabetes examined the relationships of health, behavioral, and sociodemographic characteristics with obesity. The proportion of physical inactivity was significantly higher among those with type 2 diabetes (15.0% vs. 6.1%). Individuals with diabetes had more chronic diseases, more limitations in activities, higher body mass index, more depression, lower quality of life and well-being, and lower employment rate. Among those with type 2 diabetes, those employed were more likely to be obese (OR = 1.377, 95% CI, 1.023 to 1.853) and women were 52% more likely to be obese than men. The surveillance of weight in working environments should be required within workers with type 2 diabetes. It is concluded that this and other adjustments could be beneficial in people with diabetes.<\/jats:p>","DOI":"10.3390\/ijerph15122677","type":"journal-article","created":{"date-parts":[[2018,11,28]],"date-time":"2018-11-28T11:43:44Z","timestamp":1543405424000},"page":"2677","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Obesity in Older Type 2 Diabetic Patients: Does Working Environment Add Vulnerability?"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9272-0387","authenticated-orcid":false,"given":"Maria Piedade","family":"Brand\u00e3o","sequence":"first","affiliation":[{"name":"ESSUA\u2014Health School, University of Aveiro, 3810-193 Aveiro, Portugal"},{"name":"CINTESIS\u2014Center for Health Technology and Services Research, University of Porto, 4200-450 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0042-5853","authenticated-orcid":false,"given":"Margarida Fonseca","family":"Cardoso","sequence":"additional","affiliation":[{"name":"ICBAS\u2014Instituto de Ci\u00eancias Biom\u00e9dicas de Abel Salazar, University of Porto, 4050-313 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2018,11,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.diabres.2017.03.024","article-title":"IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040","volume":"128","author":"Ogurtsova","year":"2017","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.diabres.2013.11.007","article-title":"Diabetes in Europe: An update","volume":"103","author":"Tamayo","year":"2014","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e012742","DOI":"10.1136\/bmjopen-2016-012742","article-title":"Association between obesity indices and type 2 diabetes mellitus among middle-aged and elderly people in Jinan, China: A cross-sectional study","volume":"6","author":"Wang","year":"2016","journal-title":"BMJ Open"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Guh, D.P., Zhang, W., Bansback, N., Amarsi, Z., Birmingham, C.L., and Anis, A.H. (2009). The incidence of co-morbidities related to obesity and overweight: A systematic review and meta-analysis. BMC Public Health, 9.","DOI":"10.1186\/1471-2458-9-88"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Balducci, S., D\u2019Errico, V., Haxhi, J., Sacchetti, M., Orlando, G., Cardelli, P., Di Biase, N., Bollanti, L., Conti, F., and Zanuso, S. (2017). Level and correlates of physical activity and sedentary behavior in patients with type 2 diabetes: A cross-sectional analysis of the Italian Diabetes and Exercise Study_2. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0173337"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e30","DOI":"10.1016\/j.diabres.2014.08.019","article-title":"Trends in the prevalence of type 2 diabetes mellitus and obesity in the Arabian Gulf States: Systematic review and meta-analysis","volume":"106","author":"Alharbi","year":"2014","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1016\/j.ijcard.2016.04.090","article-title":"Cardiovascular disease, diabetes and early exit from paid employment in Europe; the impact of work-related factors","volume":"215","author":"Burdorf","year":"2016","journal-title":"Int. J. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/j.ssresearch.2018.01.007","article-title":"The scarring effect of unemployment on psychological well-being across Europe","volume":"72","author":"Mousteri","year":"2018","journal-title":"Soc. Sci. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1257\/jep.24.1.119","article-title":"Mental Retirement","volume":"24","author":"Rohwedder","year":"2010","journal-title":"J. Econ. Perspect."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2157","DOI":"10.3389\/fpsyg.2017.02157","article-title":"Early Retirement: A Meta-Analysis of Its Antecedent and Subsequent Correlates","volume":"8","author":"Topa","year":"2017","journal-title":"Front. Psychol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1720","DOI":"10.1056\/NEJMoa1504347","article-title":"Excess Mortality among Persons with Type 2 Diabetes","volume":"373","author":"Tancredi","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1528","DOI":"10.1007\/s00125-014-3270-4","article-title":"Genetic susceptibility to type 2 diabetes and obesity: From genome-wide association studies to rare variants and beyond","volume":"57","author":"Grarup","year":"2014","journal-title":"Diabetologia"},{"key":"ref_13","unstructured":"National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health (2014). The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Gray, E., Shields, C., and Fowles, J.R. (2017). Building Competency and Capacity for Promotion of Effective Physical Activity in Diabetes Care in Canada. Can. J. Diabetes.","DOI":"10.1016\/j.jcjd.2016.11.005"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Arena, R., Sagner, M., Byrne, N.M., Williams, A.D., McNeil, A., Street, S.J., and Hills, A.P. (2017). Novel approaches for the promotion of physical activity and exercise for prevention and management of type 2 diabetes. Eur. J. Clin. Nutr.","DOI":"10.1038\/ejcn.2017.53"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.2337\/diacare.27.5.1047","article-title":"Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030","volume":"27","author":"Wild","year":"2004","journal-title":"Diabetes Care"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1467171","DOI":"10.1155\/2018\/1467171","article-title":"State of Diabetes Self-Management Education in the European Union Member States and Non-EU Countries: The Diabetes Literacy Project","volume":"2018","author":"Riemenschneider","year":"2018","journal-title":"J. Diabetes Res."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Ruston, A., Smith, A., and Fernando, B. (2013). Diabetes in the workplace\u2014Diabetic\u2019s perceptions and experiences of managing their disease at work: A qualitative study. BMC Public Health, 13.","DOI":"10.1186\/1471-2458-13-386"},{"key":"ref_19","first-page":"371","article-title":"Secondary analysis of existing data: Opportunities and implementation","volume":"26","author":"Cheng","year":"2014","journal-title":"Shanghai Arch. Psychiatry"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1093\/ije\/dyt088","article-title":"Data Resource Profile: The Survey of Health, Ageing and Retirement in Europe (SHARE)","volume":"42","author":"Brandt","year":"2013","journal-title":"Int. J. Epidemiol."},{"key":"ref_21","unstructured":"Malter, F., Schuller, K., and B\u00f6rsch-Supan, A. (2016). SHARE Compliance Profiles\u2014Wave 6, MEA, Max Planck Institute for Social Law and Social Policy."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1016\/j.gaceta.2013.03.002","article-title":"Socioeconomic inequalities in the incidence and prevalence of type 2 diabetes mellitus in Europe","volume":"27","author":"Espelt","year":"2013","journal-title":"Gac. Sanit."},{"key":"ref_23","unstructured":"(2018, February 02). UNESCO International Standard Classification of Education (ISCED 2011). Available online: http:\/\/www.unesco.org\/education\/information\/nfsunesco\/doc\/isced_1997.htm."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1080\/13607863.2015.1018868","article-title":"A decade of research using the CASP scale: Key findings and future directions","volume":"19","author":"Hyde","year":"2015","journal-title":"Aging Ment. Health"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1080\/1360786031000101157","article-title":"A measure of quality of life in early old age: The theory, development and properties of a needs satisfaction model (CASP-19)","volume":"7","author":"Hyde","year":"2003","journal-title":"Aging Ment. Health"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1192\/bjp.174.4.330","article-title":"Development of the EURO-D scale--a European, Union initiative to compare symptoms of depression in 14 European centres","volume":"174","author":"Prince","year":"1999","journal-title":"Br. J. Psychiatry"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"409","DOI":"10.20344\/amp.9613","article-title":"Threats to Health and Well-Being Perceived by Older People in Poland and Portugal","volume":"31","author":"Brandao","year":"2018","journal-title":"Acta Med. Port."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1080\/13607863.2017.1292208","article-title":"Psychometric properties of the CASP-12 in a Spanish older community dwelling sample","volume":"22","author":"Martin","year":"2018","journal-title":"Aging Ment. Health"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Guerra, M., Ferri, C., Llibre, J., Prina, A.M., and Prince, M. (2015). Psychometric properties of EURO-D, a geriatric depression scale: A cross-cultural validation study. BMC Psychiatry, 15.","DOI":"10.1186\/s12888-015-0390-4"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1210\/er.2015-1137","article-title":"Sex and Gender Differences in Risk, Pathophysiology and Complications of Type 2 Diabetes Mellitus","volume":"37","author":"Harreiter","year":"2016","journal-title":"Endocr. Rev."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1136\/jech.2004.028795","article-title":"Wider income gaps, wider waistbands? An ecological study of obesity and income inequality","volume":"59","author":"Pickett","year":"2005","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1038\/ejcn.2014.86","article-title":"Global differences between women and men in the prevalence of obesity: Is there an association with gender inequality?","volume":"68","author":"Garawi","year":"2014","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1016\/j.socscimed.2012.03.029","article-title":"Associations of economic and gender inequality with global obesity prevalence: Understanding the female excess","volume":"75","author":"Wells","year":"2012","journal-title":"Soc. Sci. Med."},{"key":"ref_34","unstructured":"(2017, July 06). World Health Organization Global Report on Diabetes. Available online: http:\/\/www.who.int\/diabetes\/global-report\/en\/."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1111\/dom.12270","article-title":"Prevention of type 2 diabetes; a systematic review and meta-analysis of different intervention strategies","volume":"16","author":"Merlotti","year":"2014","journal-title":"Diabetes Obes. Metab."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1824","DOI":"10.2337\/dc13-2899","article-title":"The effects of a Mediterranean diet on the need for diabetes drugs and remission of newly diagnosed type 2 diabetes: Follow-up of a randomized trial","volume":"37","author":"Esposito","year":"2014","journal-title":"Diabetes Care"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"449","DOI":"10.3945\/an.116.014100","article-title":"A Systematic Review of Application and Effectiveness of mHealth Interventions for Obesity and Diabetes Treatment and Self-Management","volume":"8","author":"Wang","year":"2017","journal-title":"Adv. Nutr."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"59","DOI":"10.7748\/ns.2017.e10672","article-title":"The role of obesity in the onset of type 2 diabetes mellitus","volume":"31","author":"Cloete","year":"2017","journal-title":"Nurs. Stand."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1038\/aps.2009.49","article-title":"Impact of cigarette smoking in type 2 diabetes development","volume":"30","author":"Xie","year":"2009","journal-title":"Acta Pharmacol. Sin."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1111\/j.1365-2265.2012.04331.x","article-title":"Body fat distribution in relation to smoking and exogenous hormones in British women","volume":"77","author":"Kwok","year":"2012","journal-title":"Clin. Endocrinol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1466","DOI":"10.1038\/oby.2005.177","article-title":"Cigarette smoking and fat distribution in 21,828 British men and women: A population-based study","volume":"13","author":"Canoy","year":"2005","journal-title":"Obes. Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"130","DOI":"10.3945\/ajcn.116.147157","article-title":"Central adiposity and the overweight risk paradox in aging: Follow-up of 130,473 UK Biobank participants","volume":"106","author":"Bowman","year":"2017","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"316","DOI":"10.3961\/jpmph.2012.45.5.316","article-title":"Smoking is associated with abdominal obesity, not overall obesity, in men with type 2 diabetes","volume":"45","author":"Yun","year":"2012","journal-title":"J. Prev. Med. Public Health"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.archger.2013.02.004","article-title":"Relationship between employment status and obesity in a Korean elderly population, based on the 2007\u20132009 Korean National Health and Nutrition Examination Survey (KNHANES)","volume":"57","author":"Kang","year":"2013","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"808","DOI":"10.2337\/dc15-1942","article-title":"Very Low-Calorie Diet and 6 Months of Weight Stability in Type 2 Diabetes: Pathophysiological Changes in Responders and Nonresponders","volume":"39","author":"Steven","year":"2016","journal-title":"Diabetes Care"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s13643-016-0200-1","article-title":"The effectiveness of workplace dietary interventions: Protocol for a systematic review and meta-analysis","volume":"5","author":"Smith","year":"2016","journal-title":"Syst. Rev."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1186\/s13643-015-0166-4","article-title":"The effectiveness of workplace interventions to increase physical activity and decrease sedentary behaviour in adults: Protocol for a systematic review","volume":"4","author":"Loitz","year":"2015","journal-title":"Syst. Rev."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1186\/2046-4053-3-128","article-title":"Financial incentive policies at workplace cafeterias for preventing obesity--a systematic review and meta-analysis (Protocol)","volume":"3","author":"Sawada","year":"2014","journal-title":"Syst. Rev."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/j.ypmed.2011.01.031","article-title":"Efficacy of a workplace-based weight loss program for overweight male shift workers: The Workplace POWER (Preventing Obesity without Eating like a Rabbit) randomized controlled trial","volume":"52","author":"Morgan","year":"2011","journal-title":"Prev. Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"6","DOI":"10.3389\/fendo.2017.00006","article-title":"Clinical Review of Antidiabetic Drugs: Implications for Type 2 Diabetes Mellitus Management","volume":"8","author":"Chaudhury","year":"2017","journal-title":"Front. Endocrinol. (Lausanne)"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"McCurley, J.L., Crawford, M.A., and Gallo, L.C. (2017). Prevention of Type 2 Diabetes in U.S. Hispanic Youth: A Systematic Review of Lifestyle Interventions. Am. J. Prev. Med.","DOI":"10.1016\/j.amepre.2017.05.020"},{"key":"ref_52","unstructured":"(2017, August 03). Centers for Disease Control and Prevention National Diabetes Statistics Report, 2017, Available online: https:\/\/www.cdc.gov\/diabetes\/data\/statistics\/statistics-report.html."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1001\/jama.2017.0686","article-title":"Association of Type 1 Diabetes vs Type 2 Diabetes Diagnosed During Childhood and Adolescence With Complications During Teenage Years and Young Adulthood","volume":"317","author":"Dabelea","year":"2017","journal-title":"JAMA"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/15\/12\/2677\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T15:32:51Z","timestamp":1760196771000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/15\/12\/2677"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,11,28]]},"references-count":53,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2018,12]]}},"alternative-id":["ijerph15122677"],"URL":"https:\/\/doi.org\/10.3390\/ijerph15122677","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,11,28]]}}}