Adherence to a Healthy Lifestyle in Association With Microvascular Complications Among Adults With Type 2 Diabetes
Authors' conclusion
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.
Study context
- Population
- Incident T2D patients free of CVD and cancer at diagnosis, Nurses' Health Study and Health Professionals Follow-Up Study (US); mean age 61 years, 94.2% White4,982 women · 2,095 men
- Participants
- 7,077 patients
- Exposure
- ≥4 vs 0 low-risk lifestyle factors before and after diabetes diagnosis
- Outcome
- Physician-diagnosed microvascular complications (diabetic neuropathy, retinopathy, nephropathy, foot disorders), self-reported
Methodological detailsNurses' Health Study and Health Professionals Follow-Up Study, multivariable-adjusted, Data analyzed April to August 2021
- Nurses' Health Study and Health Professionals Follow-Up Study
- Multivariable-adjusted
- Data analyzed April to August 2021
Main finding
As reported in the abstract
Any microvascular complications
≥4 low-risk factors vs 0 low-risk factorsRelative risk (95% CI)
Lifestyle before diabetes diagnosis
0.73(0.60–0.91)
Lifestyle after diabetes diagnosis
0.68(0.55–0.83)
- Patients developing microvascular complications during follow-up
- 2878
Observational data: associations, not effects.
Further findings
| Outcome | RR (95% CI) | |
|---|---|---|
| Diabetic neuropathy≥4 low-risk factorsvs 0 low-risk factorsBefore diagnosis | 0.71 (0.54–0.93) | |
| Diabetic neuropathy≥4 low-risk factorsvs 0 low-risk factorsAfter diagnosis | 0.67 (0.51–0.88) | |
| Diabetic retinopathy≥4 low-risk factorsvs 0 low-risk factorsBefore diagnosis | 0.76 (0.57–1.01) | |
| Diabetic retinopathy≥4 low-risk factorsvs 0 low-risk factorsAfter diagnosis | 0.65 (0.48–0.86) | |
| Diabetic nephropathy≥4 low-risk factorsvs 0 low-risk factorsBefore diagnosis | 0.42 (0.23–0.79) | |
| Diabetic nephropathy≥4 low-risk factorsvs 0 low-risk factorsAfter diagnosis | 0.57 (0.34–0.98) | |
| Diabetic foot disorders≥4 low-risk factorsvs 0 low-risk factorsBefore diagnosis | 0.60 (0.35–1.00) | |
| Diabetic foot disorders≥4 low-risk factorsvs 0 low-risk factorsAfter diagnosis | 0.62 (0.37–1.05) | |
| 0.20.5125Relative risk (log scale) |
Per increment in number of low-risk lifestyle factors
- Any microvascular complications, RR (95% CI 0.90-0.98); 6% lower risk
- 0.94
- Diabetic neuropathy, RR (95% CI 0.86-0.96); 9% lower risk
- 0.91
- Greater lifestyle improvement from before to after diagnosis: significantly lower risk of neuropathy or total microvascular complications
- Consistent results when stratified by age at diagnosis, sex/cohort or pre-diagnosis lifestyle
Original publication
Adherence to a Healthy Lifestyle in Association With Microvascular Complications Among Adults With Type 2 Diabetes. JAMA Netw Open. Published 3 January 2023. doi:10.
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