Association of a Healthy Lifestyle With All-Cause and Cause-Specific Mortality Among Individuals With Type 2 Diabetes: A Prospective Study in UK Biobank

Dec 3, 2021Diabetes care

Healthy Lifestyle Linked to Lower Overall and Cause-Specific Death Rates in People With Type 2 Diabetes

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Abstract

Among 13,366 participants with type 2 diabetes, a healthy lifestyle was associated with a hazard ratio of 0.42 for all-cause mortality.

Each of the seven low-risk lifestyle factors was significantly linked to reduced all-cause mortality.
A lifestyle score of 6-7 compared to 0-2 was associated with lower mortality from cancer (hazard ratio 0.57) and cardiovascular disease (hazard ratio 0.35).
The analysis indicated that 29.4% of deaths were attributed to a poor lifestyle score of 0-5.
The relationship between a healthy lifestyle and lower all-cause mortality was consistent across various indicators of diabetes severity.

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OBJECTIVE: To evaluate the association of a healthy lifestyle, involving seven low-risk factors mentioned in diabetes management guidelines (no current smoking, moderate alcohol consumption, regular physical activity, healthy diet, less sedentary behavior, adequate sleep duration, and appropriate social connection), with all-cause and cause-specific mortality among individuals with type 2 diabetes.

RESEARCH DESIGN AND METHODS: This study included 13,366 participants with baseline type 2 diabetes from the UK Biobank free of cardiovascular disease (CVD) and cancer. Lifestyle information was collected through a baseline questionnaire.

RESULTS: During a median follow-up of 11.7 years, 1,561 deaths were documented, with 625 from cancer, 370 from CVD, 115 from respiratory disease, 81 from digestive disease, and 74 from neurodegenerative disease. In multivariate-adjusted model, each lifestyle factor was significantly associated with all-cause mortality, and hazard ratios associated with the lifestyle score (scoring 6-7 vs. 0-2 unless specified) were 0.42 (95% CI 0.34, 0.52) for all-cause mortality, 0.57 (0.41, 0.80) for cancer mortality, 0.35 (0.22, 0.56) for CVD mortality, 0.26 (0.10, 0.63) for respiratory mortality, and 0.28 (0.14, 0.53) for digestive mortality (scoring 5-7 vs. 0-2). In the population-attributable risk analysis, 29.4% (95% CI 17.9%, 40.9%) of deaths were attributable to a poor lifestyle (scoring 0-5). The association between a healthy lifestyle and all-cause mortality was consistent, irrespective of factors reflecting diabetes severity (diabetes duration, glycemic control, diabetes-related microvascular disease, and diabetes medication).

CONCLUSIONS: A healthy lifestyle was associated with a lower risk of all-cause mortality and mortality due to CVD, cancer, respiratory disease, and digestive disease among individuals with type 2 diabetes.

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Association of a Healthy Lifestyle With All-Cause and Cause-Specific Mortality Among Individuals With Type 2 Diabetes: A Prospective Study in UK Biobank

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