medwireNews: Researchers find that controlling modifiable risk factors limits the risk for developing type 2 diabetes in women with previous gestational diabetes, even if they have overweight or high genetic risk.
Having optimal BMI, diet quality, physical activity, and alcohol intake, as well as not smoking, was associated with a more than 90% reduced risk for developing type 2 diabetes compared with having non-optimal levels of all five factors.
The study cohort comprised 4275 women from the Nurses’ Health Study II who had experienced gestational diabetes. During a median follow-up of 27.9 years, 924 of these women were diagnosed with type 2 diabetes.
“Despite the fact that our study cohort consisted entirely of registered nurses, less than 20% of the population reported having optimal levels of four or more risk factors over the follow-up, indicating the substantial public health opportunity to reduce type 2 diabetes among these high risk women,” write Cuilin Zhang (National University of Singapore) and study co-authors in The BMJ.
Just 2% of the women had optimal levels of all five risk factors and 13% had optimal levels of four, with 30%, 34%, 19%, and 2% having optimal levels of three, two, one, and none, respectively.
Having optimal levels of at least two of these factors significantly reduced the risk for developing type 2 diabetes, by a significant 39%, 68%, 85%, and 92% for two, three, four, and five factors, respectively, compared with none.
The researchers say that, of the five risk factors, BMI was most strongly associated with type 2 diabetes risk.
“Furthermore, adjustment for body mass index substantially attenuated associations of other lifestyle factors with risk of type 2 diabetes, which highlights the importance of maintaining a healthy weight after pregnancies complicated by gestational diabetes mellitus,” they write.
However, they stress that, among the 2227 women who were overweight or obese, having optimal levels of the other four risk factors was associated with a 60% reduction in type 2 diabetes risk compared with having none at optimal levels.
Likewise, among the 1372 women with a high genetic risk (above-median score based on 59 genetic variants linked to type 2 diabetes), having optimal levels of all five risk factors was associated with an 89% risk reduction.
Indeed, there were no cases of type 2 diabetes among women who had high genetic risk but optimal levels of all risk factors.
The researchers caution that all their study participants were healthcare professionals and predominantly of European ancestry, potentially limiting the generalizability of the findings, but nonetheless conclude that the results highlight “the important public health opportunity for the prevention of type 2 diabetes in this high risk population.”
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