Diabetes prevention in five steps: Study

By Dr. Ananya Mandal, MDSep 6 2011

According to a new study meeting just one of five key health goals reduces the odds of developing diabetes in middle age by roughly one-third. The report adds that the more goals are met the lower the risk falls, even if there is a family history of diabetes.

The new study is the largest of its kind to date and it explores how several healthy habits combine to affect diabetes risk. “The question we were trying to raise is whether there are added benefits to each individual lifestyle improvement you make, and it looks like that answer is definitely yes,” says Jared Reis, the lead author of the study and an epidemiologist with the National Heart, Lung, and Blood Institute in Bethesda, Maryland. “The strength of the association was really very dramatic and quite surprising.”

The researchers analyzed data from more than 200,000 men and women in eight states who are part of a long-running study on diet and health led by the National Cancer Institute. In the mid-1990s, when they ranged in age from 50 to 71 and showed no signs of serious illness, the study participants answered detailed questionnaires about their diet, lifestyle, medical history, physical characteristics and demographic profile.

Ten years later, roughly 9% of the men and women had developed diabetes. Those who were least likely to receive a diabetes diagnosis shared five key health attributes. These include;

1. Normal weight and body mass index below 25
2. Non-smoking – never-smokers or smoke free for a decade.
3. Physically active – at least 20 minutes of vigorous exercise three or more times per week.
4. Healthy diet – with lots of fiber, little trans fat, few refined or sugary carbohydrates, and a high ratio of good (polyunsaturated) to bad (saturated) fats.
5. Little to no drinking - two drinks or less a day for men, and one drink or less for women.

Each additional attribute was associated, on average, with 31% and 39% lower odds of developing diabetes among men and women, respectively. People who met all five standards had roughly 80% lower odds of a diabetes diagnosis than demographically similar people who led less healthy lifestyles, according to the study, which was published in the Annals of Internal Medicine.

Researchers note that of all five lifestyle factors, being overweight was linked most strongly to diabetes risk. But having healthy marks for the other four factors still made a difference in overall risk, regardless of whether a person was normal weight, overweight or obese.

“It isn't always an easy thing to lose weight and to maintain that weight loss over the long term,” Reis says. “So this is good news for those individuals who have a tough time losing weight: You can still lower your risk with these other lifestyle changes.”

The study's large, real-world population may actually be a strength, says Robert Henry, the president of medicine and science at the American Diabetes Association, an advocacy organization based in Alexandria, Virginia. “This study looked at factors we know can be easily modifiable, and the conditions that people actually live with in real life,” says Henry, who is also a professor of endocrinology and metabolism at the University of California-San Diego. “And it does that better than some of the diligently done clinical trials that may not be applicable to a normal lifestyle situation.”

The study also found that maintaining the five lifestyle factors lowers diabetes risk regardless of family history, suggesting that people with a genetic predisposition can still prevent or at least delay the onset of the disease.

Reis noted that it helps to start living a healthy lifestyle at any age. Even in middle age, it will reap benefits in lowering your risk for diabetes, he said. “It's never too late.”

Diabetes expert Dr. Spyros G. Mezitis, from New York Presbyterian Hospital in New York City, said that “we have known that lifestyle factors affect prevention, development and management of diabetes.” Mezitis noted that the combination of lifestyle factors can reduce the risk of developing diabetes. “We need to look at these factors and how by modifying them you can really reduce the risk of diabetes,” he said. However, Mezitis thinks changing these behaviors can be hard for people to do, especially without support from society at large. “We really need to be thinking of prevention early, and we need the help of government and business and others to achieve these goals,” he said.