Resolve to Be Healthier May Actually Help Reduce T2DM

With the New Year come resolutions and for many people that means trying to adopt a healthier lifestyle. Physicians have long been advised to counsel patients on diet and exercise modifications to help reduce the risk of diabetes and other chronic health conditions. But how much of a difference does this make on a wider scale? 

A population-based prospective cohort study conducted in Sweden over the course of 10 years provides fresh evidence that sticking to New Year’s resolutions can make a big difference. The study found that an intervention aimed at improving health behaviors in the general population could reduce long-term incidence of diabetes between 1.5% and 34.4%. 

The study was published online on December 19, 2014, in the journal Preventive Medicine.

“The most important thing [about our study] is that everyday healthy living should be promoted in the majority of patients,” commented senior author Margareta Norberg, MD, senior lecturer in the department of public health and clinical medicine at UmeÃ¥ University in Sweden. 

Past studies have suggested that intensive lifestyle interventions in people who already have impaired glucose tolerance can reduce the incidence of type 2 diabetes mellitus (T2DM). However, research suggests that most cases of diabetes could be expected to arise from the larger low-risk population.

“Given the difficulties and costs of identifying people at high risk, coupled with the low uptake of intensive interventions in high-risk individuals, interventions targeting the wider collective determinants of elevated blood glucose levels are needed,” Dr Norberg explained.

The study took advantage of a population enrolled in a health promotion intervention integrated into primary care practices in Västerbotten County, Sweden, between 1990 and 2013. The cohort included 32,120 individuals between the ages of 35 and 55 years (53.1% women, 48.2% overweight or obese). Researchers looked at baseline clinical parameters (blood pressure, lipids, oral glucose tolerance test, BMI, and waist circumference) and results of self-reported diet and exercise questionnaires. Regression analysis quantified the association between reaching 6 behavioral goals at balseline (BMI <25 kg/m², moderate physical activity/exercise, non-smoker, fat intake <30% of energy, fiber intake ≥15 g/4184 kJ, and alcohol intake ≤20 g/d) and the incidence of diabetes over 10 years.

Key results included:

  • Development of T2DM: 7% (n=2211) participants

  • Percentage meeting all 6 goals: 4.4% (n=1245)

  • Those meeting 0 or 1 goal had 3.74 times higher diabetes incidence compared with those meeting all 6 goals.

Estimated cases of T2DM prevented by meeting:

   • 2 goals: 1.5% (95% CI, 1.1% to 2.0%)

  • 3 goals: 5.9% (95% CI, 4.6% to 7.1%)

  • 4 goals: 14.1% (95% CI, 11.7% to 16.5%)

  • 5 goals: 25.8% (95% CI, 21.7% to 29.6%)

  • 6 goals: 34.4% (95% CI, 27.9% to 42.4%)

Having a healthy BMI, moderate physical activity, and not smoking had the largest effects on reducing T2DM incidence

“To maintain a healthy body weight, be moderately physically active, and abstain from tobacco use is probably more realistic and really rewarding in terms of good health from both the individual and the population health perspective,” Dr Norberg commented.

For example, avoiding weight gain by eating smaller amounts may be easier than trying to maintain a healthy weight after having gained and lost a large amount, according to Dr Norberg. Exercise does not need to be intensive, she emphasized. She encouraged integrating healthy behaviors into everyday life, like walking or biking to work (when possible), and taking the stairs instead of the elevator.

That said, Dr Norberg notes that the study could be limited because the majority of the population in Sweden is familiar and confident with primary care.

“The study was organized and delivered within an established and stable structure, which is the routine of primary care,” Dr Norberg pointed out, “so in settings where this is not possible to achieve, our findings might [be less] relevant.

“On the other hand,” she emphasized, “there is no need for costly or complicated investments for practitioners to talk to patients about their daily lifestyle habits and to motivate more healthy living.” Other health promotion interventions, she mentioned, are also important. 

“Population health promotion programs or fiscal strategies aimed at unhealthy foods, similar to tobacco reduction policies, could change cultural norms and may exert additional effects on population health,” she concluded. “Strategies to promote individuals’ health combined with wider community-based health promotion strategies would be most successful to improve public health.”

References:

Long GH, Johansson I, Rolandsson O, et al. Healthy behaviors and 10-year incidence of diabetes: A population cohort study. Preventive Medicine. Published online Dec 19 2014. doi: 10.1016/j.ypmed.2014.12.013