Adopting a very healthy lifestyle reduces risk for incident type 2 diabetes (T2D) by 75% compared with an unhealthy lifestyle, according to study results published in Diabetologia.

Researchers conducted a systematic review to summarize research that has investigated the effect of healthy lifestyle habits on incident diabetes and prognosis for patients with T2D. They searched EMBASE and PubMed form inception through April 2019 for cohort studies that investigated the combined associations of ≥3 lifestyle factors with incident T2D and health outcomes in patients with diabetes. Random-effects models were used to calculate summary hazard ratios [HRs], allowing for heterogeneity among the included studies.

Overall, the researchers identified 16 studies with 1,116,248 patients for meta-analyses of incident T2D. Another 10 studies with 34,385 individuals with T2D were used for meta-analyses of mortality and incident cardiovascular disease.

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The results indicated that individuals with the healthiest lifestyle had a 75% lower risk for incident diabetes compared with those with the least healthy lifestyle (HR, 0.25; 95% CI, 0.18-0.35). Associations were generally consistent and significant for patients with different socioeconomic backgrounds and baseline characteristics.

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For patients with T2D, those with the healthiest lifestyle had an HR of 0.44 (95% CI, 0.33-0.60) for all-cause mortality, 0.51 (95% CI, 0.30-0.86) for cardiovascular death, 0.69 (95% CI, 0.47-1.00) for cancer death, and 0.48 (95% CI, 0.37-0.63) for incident cardiovascular disease compared with those with the least healthy lifestyle.

The analysis included several limitations. The researchers noted that most included studies were conducted in high-income countries with a majority of white patients. In addition, the definitions and combinations of healthy lifestyle factors varied across the included studies, which could contribute to heterogeneity.

“Given that the proportion of individuals with the healthiest lifestyle was low in most populations, promotion of an overall healthy lifestyle, instead of tackling one particular lifestyle factor, should be a public health priority for all countries,” the researchers wrote.

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Zhang Y, Pan XF, Chen J, et al. 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 [published online September 4, 2019]. Diabetologia. doi:10.1007/s00125-019-04985-9