Combined lifestyle factors and risk of incident type 2 diabetes and prognosis among individuals with type 2 diabetes: a systematic review and meta-analysis of prospective cohort studies

Abstract

Aims/hypothesis A healthy lifestyle has been widely recommended for the prevention and management of type 2 diabetes. However, no systematic review has summarised the relationship between combined lifestyle factors (including, but not limited to, smoking, alcohol drinking, physical activity, diet and being overweight or obese) and incident type 2 diabetes and risk of health outcomes among diabetic individuals. Methods EMBASE and PubMed were searched up to April 2019 without language restrictions. References included in articles in relevant publications were also screened. Cohort studies investigating the combined associations of at least three lifestyle factors with incident type 2 diabetes and health outcomes among diabetic individuals were included. Reviewers were paired and independently screened studies, extracted data and evaluated study quality. Random-effects models were used to calculate summary HRs. Heterogeneity and publication bias tests were also conducted. Results Compared with participants considered to have the least-healthy lifestyle, those with the healthiest lifestyle had a 75% lower risk of incident diabetes (HR 0.25 [95% CI 0.18, 0.35]; 14 studies with approximately 1 million participants). The associations were largely consistent and significant among individuals from different socioeconomic backgrounds and baseline characteristics. Among individuals with type 2 diabetes (10 studies with 34,385 participants), the HRs (95% CIs) were 0.44 (0.33, 0.60) for all-cause death, 0.51 (0.30, 0.86) for cardiovascular death, 0.69 (0.47, 1.00) for cancer death and 0.48 (0.37, 0.63) for incident cardiovascular disease when comparing the healthiest lifestyle with the least-healthy lifestyle. Conclusions/interpretation Adoption of a healthy lifestyle is associated with substantial risk reduction in type 2 diabetes and long-term adverse outcomes among diabetic individuals. Tackling multiple risk factors, instead of concentrating on one certain lifestyle factor, should be the cornerstone for reducing the global burden of type 2 diabetes.

Adherence to healthy lifestyles and incidence of diabetes and mortality among individuals with diabetes: a systematic review and meta-analysis of prospective studies

“…Recently, a meta-analysis summarised studies on the association between combined lifestyle factors and T2D as well as incident cardiovascular diseases and mortality in individuals with diabetes. 16 However, the authors combined studies investigating lifestyle indices and cardiovascular risk markers such as blood pressure, blood lipids and blood glucose. These surrogate markers are influenced by lifestyle factors as well as genetic predisposition, and cannot be considered as lifestyle factors by itself.…”

Associations of Residential Greenness with Diabetes Mellitus in Chinese Uyghur Adults

“…The etiology of diabetes mellitus is complex and is thought to be influenced by both genetic and environmental factors [3]. For environmental factors, high-sugar, high-fat, and high-energy diet habits, lack of physical activity, being overweight/obese, and exposure to air pollution have been reported to increased risk of diabetes mellitus [4][5][6]. Recently, diabetic effects of greenness have attracted more and more researchers' attention worldwide.…”

Therapie des Typ-2-Diabetes

“…Die Anpassung an einen gesunden Lebensstil ist von entscheidender Bedeutung nicht nur zur Prävention eines Typ-2-Diabetes, sondern auch zur Reduktion der komplexen Pharmakotherapie und der Entstehung und Progression diabetischer Komplikationen des Typ-2-Diabetes. Dabei ist es sinnvoll, nicht nur einen, sondern möglichst viele Risikofaktoren durch Lebensstilmodifikation anzugehen [7].…”

“…Eine umfangreiche Analyse aller Berichte über Ketoazidosen mit einem möglichen Zusammenhang mit SGLT2-Inhibitoren, die in der Zeit von Januar 2014 bis Oktober 2016 im US Food and Drug Administration Adverse Event Reporting System (FAERS) gelistet wurden, ist publiziert worden [115]. Dabei fand sich eine Proportional Reporting Ratio (PPR) von 7,9 (95 %- KI 7,[5][6][7][8]4 Damit ist für den SGLT2-Inhibitor Empagliflozin eindrücklich dessen positive Wirkung auf die Gesamtmortalität sowie die kardiovaskulären und renalen Endpunkte bei einer entsprechenden Risikopopulation belegt und in einer neuen Metaanalyse erneut bestätigt [123].…”