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Adherence to a Healthy Lifestyle in Association With Microvascular Complications Among Adults With T2D
The association between an overall healthy lifestyle and the subsequent risk of microvascular complications among patients with diabetes remains unclear.
To examine the association between adherence to a healthy lifestyle before and after diabetes diagnosis and the risk of subsequent microvascular complications among adults with diabetes.
DESIGN, SETTING, AND PARTICIPANTS
This prospective cohort study included incident patients with type 2 diabetes who were free of cardiovascular disease and cancer at the time of diabetes diagnosis and completed the diabetes supplementary questionnaires in the Nurses' Health Study (in 2000 and 2005) and the Health Professionals Follow-Up Study (in 2000, 2004, and 2008) in the US. Data were analyzed from April to August 2021.
Diet and lifestyle factors before and after diabetes diagnosis were assessed by validated questionnaires. A healthy lifestyle consisted of nonsmoking, having a healthy body weight (a body mass index of ≥18.5 or <25), engaging in moderate-to-vigorous physical activity (≥150 minutes per week), consuming a high-quality diet (top 40th percentile of the Alternative Healthy Eating Index), and moderate alcohol drinking (5-15 g/d for women and 5-30 g/d for men).
MAIN OUTCOMES AND MEASURES
Physician-diagnosed microvascular complications including diabetic neuropathy, retinopathy, nephropathy, and foot disorders were self-reported at questionnaire surveys.
A total of 7077 patients with type 2 diabetes were included in the cohort (4982 women in NHS and 2095 men in HPFS, mean [SD] age 61 [8.8], 94.2% White). During follow-up, 2878 patients developed microvascular complications. After multivariable adjustment, adherence to a healthy lifestyle before and after diabetes diagnosis were both associated with a lower risk of developing microvascular complications. The relative risk (RR) for participants with 4 or more low-risk lifestyle factors before diabetes diagnosis compared with zero was 0.73 (95% CI, 0.60-0.91) for any microvascular complications, 0.71 (95% CI, 0.54-0.93) for diabetic neuropathy, 0.76 (95% CI, 0.57-1.01) for diabetic retinopathy, 0.42 (95% CI, 0.23-0.79) for diabetic nephropathy, and 0.60 (95% CI, 0.35-1.00) for diabetic foot disorders. Similar results were observed for adherence to a healthy lifestyle after diabetes diagnosis, with an RR of 0.68 (95% CI, 0.55-0.83) for any microvascular complications, 0.67 (95% CI, 0.51-0.88) for diabetic neuropathy, 0.65 (95% CI, 0.48-0.86) for diabetic retinopathy, 0.57 (95% CI, 0.34-0.98) for diabetic nephropathy, and 0.62 (95% CI, 0.37-1.05) for diabetic foot disorders. In addition, greater improvement in lifestyle factors from before to after diabetes diagnosis was also significantly associated with a lower risk of neuropathy or total microvascular complications. Each increment in number of low-risk lifestyle factors was associated with a 6% (RR, 0.94; 95% CI, 0.90-0.98) lower risk for any microvascular complications and a 9% (RR, 0.91; 95% CI, 0.86-0.96) lower risk for diabetic neuropathy. Consistent results were observed when analyses were stratified by age at diabetes diagnosis, sex/cohort, or lifestyle factors before diabetes diagnosis.
CONCLUSIONS AND RELEVANCE
In this cohort study, adhering to an overall healthy lifestyle was associated with a significantly lower risk of microvascular complications among individuals with diabetes. These findings suggest substantial reduction in the burden of microvascular complications associated with adopting a healthy lifestyle among patients with type 2 diabetes.
Disclosure statements are available on the authors' profiles:
Adherence to a Healthy Lifestyle in Association With Microvascular Complications Among Adults With Type 2 DiabetesJAMA Netw Open 2023 Jan 26;6(1)e2252239, G Liu, Y Li, A Pan, Y Hu, S Chen, F Qian, EB Rimm, JE Manson, MJ Stampfer, G Giatsidis, Q Sun
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
story of the week
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It is often challenging in a busy clinic to emphasize with great enthusiasm the importance of diet and lifestyle to patients with diabetes, as it is one of the hardest things for people to do. I often find that my usual advice of eating better and exercising more feels like a pro forma coda to a visit rather than rousing motivational medical guidance.
The article by Liu et al is therefore an important reminder of the power of exercise and diet for preventing some of the most feared complications of diabetes including neuropathy, retinopathy, nephropathy, and foot disorders. In this study of over 7000 patients with type 2 diabetes, adherence to a healthy lifestyle before and after the diagnosis of diabetes was associated with a lower risk of all these microvascular complications. The relative risk reduction was 24% lower for retinopathy, 29% for neuropathy, 58% for nephropathy, and 40% for diabetic foot disorders.
That simple interventions, when done regularly, prevent serious medical events is worth repeating, and advising patients that exercise and diet can reduce their risk of kidney injury, blindness, and nerve damage is a powerful message that should resonate with all patients.