In the JournalsPerspective

Healthiest lifestyle can reduce diabetes risk by 75%

Adults who practice a combination of healthy lifestyle factors, such as not smoking, avoiding alcohol, participating in physical activity and maintaining a normal weight, are 75% less likely to develop type 2 diabetes when compared with adults who maintain an unhealthy lifestyle, according to findings published in Diabetologia.

An Pan

In a meta-analysis of more than 1 million adults, researchers also found that adults with diabetes who adopted a healthy lifestyle were significantly less likely to develop incident cardiovascular disease or die of any cause when compared with those with diabetes who practiced unhealthy lifestyle habits.

“Individuals from all socioeconomic backgrounds or with different demographic characteristics are encouraged to maintain optimal weight, avoid smoking and heavy drinking, adopt a healthy diet and increase physical activity levels to prevent type 2 diabetes,” An Pan, PhD, professor at Tongji Medical College School of Public Health, Huazhong University of Science and Technology, China, told Endocrine Today. “Individuals with diabetes should also adopt healthy lifestyles to prevent cardiovascular disease and death.”

Exercising Adults 
Adults who practice a combination of healthy lifestyle factors, such as not smoking, avoiding alcohol, participating in physical activity and maintaining a normal weight, are 75% less likely to develop type 2 diabetes when compared with adults who maintain an unhealthy lifestyle.
Source:Adobe

In a systematic review and meta-analysis, Pan and colleagues analyzed data from 16 prospective studies with 1,116,248 participants assessing the relationship between combined lifestyle factors and incident type 2 diabetes, as well as the risk for total and cause-specific mortality and incident CVD, with follow-up for at least 1 year. Mean baseline age ranged from 38 to 73 years (median, 51 years), with cohort sizes ranging from 1,639 to 461,211. Mean follow-up ranged from 2.7 to 20.8 years (median, 7.8 years). Lifestyle factors analyzed were smoking, alcohol drinking, physical activity or sedentary behavior, diet, overweight or obesity and sleep duration. Some studies also included metabolic factors, such as blood pressure, blood glucose and blood lipid levels from the Life’s Simple 7 score defined by the American Heart Association.

“The healthy lifestyle scores were constructed in multiple ways (different numbers or combinations of lifestyle factors and different weights for certain lifestyle factors) in various studies but were generally reclassified into three, four or five groups based on the distribution of the score in the study population,” the researchers wrote.

Researchers pooled HRs comparing participants in the highest score group with those in the lowest score group to represent the risk estimate comparing the healthiest vs. least-healthy lifestyle.

Compared with participants considered to have the least-healthy lifestyle, those with the healthiest lifestyle had a 75% lower risk for incident type 2 diabetes (HR = 0.25; 95% CI, 0.18-0.35). Results persisted in analyses stratified by socioeconomic background and baseline characteristics.

Among individuals with type 2 diabetes (10 studies with 34,385 participants), those who maintained the healthiest lifestyle had a 56% lower risk for all-cause death (HR = 0.44; 95% CI, 0.33-0.6), a 49% lower risk for CV death (HR = 0.51; 95% CI, 0.3-0.86), a 31% lower risk for cancer death (HR = 0.69; 95% CI, 0.47-1) and a 52% lower risk for incident CVD (HR = 0.48; 95% CI, 0.37-0.63) when compared with those with type 2 diabetes considered to have the least-healthy lifestyle.

“Compared with those with the least-healthy lifestyles, individuals with the healthiest lifestyle displayed a 31% to 56% lower risk for all-cause, CV or cancer mortality and 52% lower risk for incident CVD,” Pan said. “The results support the recommendations from World Health Organization, American Diabetes Association and many other organizations that lifestyle modification should be the cornerstone for the management of diabetes.”

Pan noted that most studies were conducted in high-income countries and most participants were of white ethnicity, adding that evidence from other populations is needed. – by Regina Schaffer

For more information:

An Pan, PhD, can be reached at the Department of Epidemiology and Biostatistics, Tongji Medical College School of Public Health, Huazhong University of Science and Technology, 13 Hangking Road, Wuhan, China; email: panan@hust.edu.cn.

Disclosures: The authors report no relevant financial disclosures.

Adults who practice a combination of healthy lifestyle factors, such as not smoking, avoiding alcohol, participating in physical activity and maintaining a normal weight, are 75% less likely to develop type 2 diabetes when compared with adults who maintain an unhealthy lifestyle, according to findings published in Diabetologia.

An Pan

In a meta-analysis of more than 1 million adults, researchers also found that adults with diabetes who adopted a healthy lifestyle were significantly less likely to develop incident cardiovascular disease or die of any cause when compared with those with diabetes who practiced unhealthy lifestyle habits.

“Individuals from all socioeconomic backgrounds or with different demographic characteristics are encouraged to maintain optimal weight, avoid smoking and heavy drinking, adopt a healthy diet and increase physical activity levels to prevent type 2 diabetes,” An Pan, PhD, professor at Tongji Medical College School of Public Health, Huazhong University of Science and Technology, China, told Endocrine Today. “Individuals with diabetes should also adopt healthy lifestyles to prevent cardiovascular disease and death.”

Exercising Adults 
Adults who practice a combination of healthy lifestyle factors, such as not smoking, avoiding alcohol, participating in physical activity and maintaining a normal weight, are 75% less likely to develop type 2 diabetes when compared with adults who maintain an unhealthy lifestyle.
Source:Adobe

In a systematic review and meta-analysis, Pan and colleagues analyzed data from 16 prospective studies with 1,116,248 participants assessing the relationship between combined lifestyle factors and incident type 2 diabetes, as well as the risk for total and cause-specific mortality and incident CVD, with follow-up for at least 1 year. Mean baseline age ranged from 38 to 73 years (median, 51 years), with cohort sizes ranging from 1,639 to 461,211. Mean follow-up ranged from 2.7 to 20.8 years (median, 7.8 years). Lifestyle factors analyzed were smoking, alcohol drinking, physical activity or sedentary behavior, diet, overweight or obesity and sleep duration. Some studies also included metabolic factors, such as blood pressure, blood glucose and blood lipid levels from the Life’s Simple 7 score defined by the American Heart Association.

“The healthy lifestyle scores were constructed in multiple ways (different numbers or combinations of lifestyle factors and different weights for certain lifestyle factors) in various studies but were generally reclassified into three, four or five groups based on the distribution of the score in the study population,” the researchers wrote.

Researchers pooled HRs comparing participants in the highest score group with those in the lowest score group to represent the risk estimate comparing the healthiest vs. least-healthy lifestyle.

Compared with participants considered to have the least-healthy lifestyle, those with the healthiest lifestyle had a 75% lower risk for incident type 2 diabetes (HR = 0.25; 95% CI, 0.18-0.35). Results persisted in analyses stratified by socioeconomic background and baseline characteristics.

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Among individuals with type 2 diabetes (10 studies with 34,385 participants), those who maintained the healthiest lifestyle had a 56% lower risk for all-cause death (HR = 0.44; 95% CI, 0.33-0.6), a 49% lower risk for CV death (HR = 0.51; 95% CI, 0.3-0.86), a 31% lower risk for cancer death (HR = 0.69; 95% CI, 0.47-1) and a 52% lower risk for incident CVD (HR = 0.48; 95% CI, 0.37-0.63) when compared with those with type 2 diabetes considered to have the least-healthy lifestyle.

“Compared with those with the least-healthy lifestyles, individuals with the healthiest lifestyle displayed a 31% to 56% lower risk for all-cause, CV or cancer mortality and 52% lower risk for incident CVD,” Pan said. “The results support the recommendations from World Health Organization, American Diabetes Association and many other organizations that lifestyle modification should be the cornerstone for the management of diabetes.”

Pan noted that most studies were conducted in high-income countries and most participants were of white ethnicity, adding that evidence from other populations is needed. – by Regina Schaffer

For more information:

An Pan, PhD, can be reached at the Department of Epidemiology and Biostatistics, Tongji Medical College School of Public Health, Huazhong University of Science and Technology, 13 Hangking Road, Wuhan, China; email: panan@hust.edu.cn.

Disclosures: The authors report no relevant financial disclosures.

    Perspective
    Joshua Joseph

    Joshua Joseph

    The systematic review and meta-analysis explores the relationship between a combination of multiple lifestyle factors and the risk for developing type 2 diabetes among those without the disease and the risk for macrovascular complications and mortality in those with type 2 diabetes. While the study has several strengths, the authors appropriately acknowledge several limitations, including the lack of generalizability to non-high income countries, lack of diversity in studies and the burgeoning importance of diabetes in youth.

    The authors do not address some major issues in the study design. First, the observational nature of the studies — examining associations of exposures (combined lifestyle factors) and outcomes — has bias, as other contemporaneous exposures are difficult to account for; thus, we cannot conclude cause and effect. Second, the studies are heterogeneous in their definitions of diabetes, ranging from self-report to a combination of fasting glucose, random glucose, HbA1c and/or medications, which may overestimate or underestimate the point estimates in the study. Lastly, the authors combined studies using hazard ratios, relative risks and odds ratios. Normally in meta-analyses, the same “effect” is pooled as in meta-analyses of clinical trials. To the author’s credit, most of Hill’s Criteria of Causality are met.

    With these caveats in mind, the key finding was a 75% lower risk for incident type 2 diabetes in the group with the highest healthy lifestyle scores compared to lowest healthy lifestyle scores and a lower risk for all-cause mortality, cancer mortality, CV mortality and incident CVD.

    A recent study analyzing the change in CV health behaviors and health factor trends between 1999 and 2014 in the National Health and Nutrition Examination Surveys (NHANES) indicates that Americans have not increased their attainment of healthy lifestyle behavior. Additionally, the study’s authors have also projected the average CV health score to decline among U.S. adults between 2014 and 2050 ( Khan SS, et al. JAMA Cardiol. 2018;doi:10.1001/jamacardio.2018.0022). These sobering results were substantiated by findings presented at the American Heart Association’s Hypertension 2019 Scientific Sessions, indicating a lack of improvement overall and a potential decrease in CV health for Hispanic Americans and non-Hispanic blacks (www.ahajournals.org/doi/10.1161/hyp.74.suppl_1.P2060).

    Given that healthy lifestyle behaviors reduce the risk for diabetes and its subsequent CV complications, and current trends are showing a lack of improvement in these behaviors, more research, policies, programs and resources are desperately needed to determine the keys to healthy behavior change at the population level. Additionally, increased utilization of current successful programs, including the National Diabetes Prevention Program (DPP) and Know Diabetes by Heart, would be beneficial. Diabetes and CVD will continue to be major health threats unless all populations understand that improving modifiable risk factors in a healthy, supportive environment is instrumental in preventing diabetes and CVD.

    • Joshua Joseph, MD, FAHA
    • Assistant Professor of Medicine
      Division of Endocrinology, Diabetes and Metabolism
      Investigator, Diabetes and Metabolism Research Center
      Affiliated Faculty, Translational Data Analytics Institute
      The Ohio State University Wexner Medical Center

    Disclosures: Joseph reports no relevant financial disclosures.