Spotlight on lifestyle factors and diabetes outcomes

Several recent studies quantified the beneficial effects of a healthy lifestyle in patients with type 2 diabetes.

One study, published by the Journal of the American Heart Association (JAHA) on Aug. 23, looked at adherence to a healthy lifestyle (defined by body mass index [BMI], smoking, alcohol consumption, physical activity, sleep duration, and diet) among 13,543 type 2 diabetes patients free of macrovascular and microvascular diseases at baseline. During a median follow-up of 12.1 years, 24.2% developed macrovascular diseases and 18.9% microvascular diseases. Compared to those with a less healthy lifestyle, participants with an ideal lifestyle had significantly lower risks of either type of vascular disease (hazard ratios [HRs], 0.46 [95% CI, 0.36 to 0.59] and 0.60 [95% CI, 0.47 to 0.77], respectively). Similar results were found when patients were evaluated on their Life's Essential 8 score (which adds blood pressure, total cholesterol level, and fasting blood glucose level to the factors considered). “The associations were independent of a series of important confounders, including those related to diabetes severity and socioeconomic status,” said the study authors. An accompanying editorial highlighted the finding that greater deprivation was associated with vascular complications but noted that “the study demonstrates that adherence to a healthy lifestyle may partially ameliorate the effects of adverse socioeconomic factors.”

Another study, published by JAHA on Aug. 30, looked at the relationship between Life's Essential 8 and kidney health in 7,605 adults with diabetes from 2006 to 2020. It found an inverse association between healthy lifestyle and development of diabetic kidney disease. The healthy lifestyle score included smoking, diet, physical activity, BMI, blood pressure, total cholesterol, fasting blood sugar, and sleep duration. Patients in the highest tertile based on baseline and time-updated lifestyle scores had HRs for kidney disease of 0.77 (95% CI, 0.69 to 0.87) and 0.70 (95% CI, 0.62 to 0.78), respectively, compared with those in the lowest tertile. The authors noted that although the Essential 8 score was designed with cardiovascular health in mind, it is also relevant to renal health. “These results suggest that secondary prevention strategies for patients with diabetes, including modifying lifestyle, treating abnormal metabolic factors, and raising [diabetic kidney disease] awareness, holds great promise for diabetes management and treatment,” they wrote.

A third article, published by Diabetes Care on Aug. 7, looked at the effects of physical activity alone. It included 18,092 patients with type 2 diabetes who self-reported their leisure-time physical activity. During a median follow-up of 12.1 years, 3.7% were diagnosed with neuropathy, 10.2% with nephropathy, and 11.7% with retinopathy. Any level of physical activity was associated with a lower risk of neuropathy and nephropathy, with similar hazard ratios whether patients exercised less than, as much as, or more than levels recommended by the American Diabetes Association/World Health Organization. The change in risk of retinopathy with exercise was not significant. “For both neuropathy and nephropathy, the minimal effective physical activity level may correspond to <1.5 h of walking per week,” said the study authors. “Thus, we suggest that initiatives to increase physical activity levels among all adults with type 2 diabetes should be prioritized.”