medwireNews: Real-world data from the UK Biobank show the value of a healthy lifestyle in people with type 2 diabetes hoping to avoid microvascular complications.
“Our findings support the importance of public health programs and interventions targeting at improving health behaviors in combination to ameliorate the risk of diabetic microvascular complications”, write the researchers in PLOS Medicine.
Gang Liu (Huazhong University of Science and Technology, Wuhan, China) and colleagues examined waist circumference, smoking status, physical activity, habitual diet and alcohol intake in 15,104 people with type 2 diabetes who were free of diabetic retinopathy, neuropathy and kidney disease at baseline.
During a median follow-up of 8.1 years, 8.6% of this cohort developed a microvascular complication, comprising 3.7% with retinopathy, 4.1% with kidney disease and 2.1% with neuropathy; the likelihood of developing these outcomes was significantly associated with whether study participants followed a healthy lifestyle.
For example, the risk of diabetic retinopathy was a significant 35% lower in people who recorded four to five healthy lifestyle behaviours, compared with those who had none or one. There was also a significant 57% reduced risk of kidney disease and a 56% reduced risk of neuropathy.
And each additional healthy lifestyle behaviour was associated with a significant 13%, 22% and 27% reduced risk of retinopathy, kidney disease and neuropathy, respectively.
The researchers found that multiple biomarkers contributed to the relationship between the lifestyle behaviours and the three microvascular outcomes, together explaining 23–32% of the associations. Prominent among these were albumin, high-density lipoprotein cholesterol, triglycerides, apolipoprotein A, C-reactive protein and glycated haemoglobin.
In a linked perspective article, Yogini Chudasama and Kamlesh Khunti, both from the University of Leicester in the UK, highlight the low proportion of study participants with a healthy lifestyle; just 10.3% of the cohort had four or five of the desirable lifestyle behaviours, and 22.6% had none.
Together with previous research, this underlines “the importance of establishing an overall healthier lifestyle at the earlier stages of diabetes and promoting population and policy-level interventions”, they say.
“Relying on medication alone will not help solve the long-term complications of diabetes”, Chudasama and Khunti write, adding that “healthier lifestyle choices will also be vital in altering the trajectory of diabetes complications globally.”
The perspective authors stress, however, that “public health policies ought to also consider targeting key risk factors where instigating behavioural change may be challenging.”
They say: “For instance, some public health policies have focused on increasing access to healthy food options in areas with high levels of socioeconomic deprivation, by providing incentives for supermarkets to open in underserved communities or by implementing programs that make fresh fruits and vegetables more affordable.”
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PLoS Med 2023; 20: e1004135
PLoS Med 2023; 20: e1004152