Healthy lifestyle linked to lower microvascular complications risk in type 2 diabetes

Maintaining a healthy lifestyle — before or after type 2 diabetes diagnosis — was associated with significantly lower risk for microvascular complications for people with the disease, according to study data.

Results were published in JAMA Network Open.

“The evidence regarding the association between combined healthy lifestyle before and after diabetes diagnosis and the subsequent risk of microvascular complications remains scarce,” Gang Liu, PhD, from the department of nutrition at the Harvard T.H. Chan School of Public Health, Boston, and colleagues wrote in study background. “In addition, it remains unclear whether improvements in lifestyle practice from before to after diabetes diagnosis are associated with risks of microvascular events.”

Researchers examined diet and lifestyle factors before and after diabetes diagnosis among 7,077 adults with type 2 diabetes (mean age, 61 years; 68.7{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} women) who were free of cardiovascular disease and cancer. All participants completed the diabetes supplementary questionnaires in the Nurses’ Health Study and the Health Professionals Follow-Up Study. Healthy lifestyles were defined as not smoking, having a healthy body weight, engaging in moderate to vigorous physical activity, consuming a high-quality diet and moderate alcohol drinking.

The primary outcomes were physician-diagnosed microvascular complications, such as diabetic neuropathy, retinopathy, nephropathy and foot disorders, self-reported on the questionnaire.

During the follow-up period, 2,878 participants developed microvascular complications. Healthy lifestyle adherence before and after diabetes diagnosis were associated with lower risk for developing microvascular complications. Compared with no low-risk lifestyle factors before diabetes diagnosis, having four or more was associated with a lower risk for any microvascular complication (RR = 0.73; 95{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} CI, 0.6-0.91), diabetic neuropathy (RR = 0.71; 95{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} CI, 0.54-0.93), diabetic retinopathy (RR = 0.76; 95{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} CI, 0.57-1.01), diabetic nephropathy (RR = 0.42; 95{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} CI, 0.23-0.79) and diabetic foot disorders (RR = 0.6; 95{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} CI, 0.35-1).

Researchers observed similar results for healthy lifestyle adherence after diabetes diagnosis for any microvascular complications (RR = 0.68; 95{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} CI, 0.55-0.83), diabetic neuropathy (RR = 0.67; 95{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} CI, 0.51-0.88), diabetic retinopathy (RR = 0.65; 95{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} CI, 0.48-0.86), diabetic nephropathy (RR = 0.57; 95{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} CI, 0.34-0.98) and diabetic foot disorders (RR = 0.62; 95{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} CI, 0.37-1.05).

Researchers also noted that greater improvement in lifestyle factors from before to after diabetes diagnosis was significantly associated with lower risk for diabetic neuropathy or total microvascular complications. Each additional low-risk lifestyle factor was linked with a 6{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} lower risk for any microvascular complications and a 9{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} lower risk for diabetic neuropathy.

“These findings suggest a substantial role of lifestyle modification in the prevention of microvascular complications among individuals with type 2 diabetes and lend support for the American Diabetes Association guidelines that recommend lifestyle improvements for individuals with diabetes,” the researchers wrote.