Healthy Lifestyles May Lower Risk of Microvascular Complications

Study results indicate that exercising, following a high-quality diet, limiting alcohol intake, maintaining a healthy body weight, and not smoking protects those with type 2 diabetes.

An overall healthy lifestyle was associated with a lower risk of microvascular complications for individuals with type 2 diabetes (T2D), according to the results of a study published in JAMA Network Open.

Investigators defined an overall healthy lifestyle as exercising, following a high-quality diet, limiting alcohol intake, maintaining a healthy body weight, and not smoking.

In the study, investigators included 7077 individuals with incident T2D from 2 large prospective cohort studies.

Individuals included in the study did not have cancer or cardiovascular disease at the time they received a diabetes diagnosis. They completed the diabetes supplementary questionnaires in the Nurses’ Health Study, from 2000 and 2005, and the Health Professionals Follow-Up Study, from 2000, 2004, and 2008.

Investigators analyzed data from April to August 2021.

The questionnaires assessed participants’ diet and lifestyle factors both before and after they received diabetes diagnoses.

During the follow up, investigators reported that 2878 individuals developed microvascular complications. After adjustments, adherence to the healthy lifestyle before and after a diabetes diagnosis were both associated with lower risk of developing microvascular complications.

Additionally, investigators found that the relative risk (RR) for individuals who had 4 or more low-risk lifestyle factors before diabetes diagnosis was 0.73 for any microvascular complications. They also found that the RR was 0.60 for diabetic foot disorders, 0.42 for diabetic nephropathy, 0.71 for diabetic neuropathy, and 0.76 for diabetic retinopathy, .

Furthermore, they observed similar results for adherence to a healthy lifestyle after diabetes diagnosis with RR of 0.68 for any microvascular complications. They also found that the RR was 0.62 for diabetic food disorder, 0.57 for diabetic nephropathy, 0.67 for diabetic neuropathy, and 0.65 for diabetic retinopathy.

Greater improvements in lifestyle factors from before to after a diabetes diagnosis was also significantly associated with a lower risk of neuropathy or total microvascular complications.

Each increment in the number of low-risk lifestyle factors was associated with a 6% and 9% lower risk for any microvascular complication and diabetic neuropathy, respectively, investigators said.

Across age at diabetes diagnosis, sex/cohort, and lifestyle factors before diabetes diagnosis showed consistent results when the analyses were stratified.

Investigators think the study is the first to examine the combined dietary and lifestyle factors, as well as changes in lifestyle from before and after diabetes diagnosis with risk of microvascular complications.

Strengths of the study included detailed assessments of dietary and lifestyle factors and a large sample size, investigators said.

Additionally, they acknowledged the limitations of the study, which included that all the individuals were health professionals and were mostly non-Hispanic and White, which could limit the generalizability of the findings to other ethnic or racial groups.

Another limitation included that the lifestyle factors after a diabetes diagnosis were only assessed shortly after and the identification of microvascular complications were self-reported physician diagnosis, so the validity was not examined.


Liu G, Li Y, Pan A, Hu Y, et al. Adherence to a healthy lifestyle in association with microvascular complications among adults with type 2 diabetes. JAMA Netw Open. 2023;6(1):e2252239. doi:10.1001/jamanetworkopen.2022.52239

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