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. 2024 Sep 27:14:04195.
doi: 10.7189/jogh.14.04195.

Healthy lifestyle associated with dynamic progression of type 2 diabetes: A multi-state analysis of a prospective cohort

Yuanyuan Ma #  1 , Yufeng Chen #  2 , Aichen Ge #  3 , Guangfeng Long  4 , Min Yao  5 , Yanli Shi  4 , Xiaowei He  6
Affiliations

Healthy lifestyle associated with dynamic progression of type 2 diabetes: A multi-state analysis of a prospective cohort

Yuanyuan Ma et al. J Glob Health. .

Abstract

Background: Although the association of a healthy lifestyle with type 2 diabetes (T2D) has been extensively studied, its impact on the dynamic trajectory, including progression, onset and prognosis, of T2D has not been investigated.

Methods: Using data from the UK Biobank, 461 168 participants without diabetes or diabetes-related events were included. We incorporated four lifestyle factors to construct the healthy lifestyle score (HLS). We employed a multi-state model to examine the relationship between a healthy lifestyle and transition in T2D progression, including transitions from baseline to diabetes, complications, and further to death. The cumulative probability of above transitions based on the health lifestyle score was calculated.

Results: The results indicated that adhering to 3-4 healthy lifestyles had an inverse association with the risk of transition from baseline to diabetes (hazard ratio (HR) = 0.966; 95% confidence interval (CI) = 0.935-0.998, P = 0.038), diabetes to complications (HR = 0.869; 95% CI = 0.818-0.923, P = 5.2 × 10-6), baseline to death (HR = 0.528; 95% CI = 0.502-0.553, P < 2 × 10-16, and diabetes to death (HR = 0.765; 95% CI = 0.591-0.990, P = 0.041) compared with maintaining 0-1 healthy lifestyles. In addition, the transition probability of the above transitions can be lower with maintaining 3-4 healthy lifestyles.

Conclusions: Healthy lifestyles are negatively associated with the risk of multiple outcomes during the dynamic progression of T2D. Adherence to 3-4 healthy lifestyle behaviours before diabetes onset can lower the risk of developing T2D, further reducing the risk of diabetes complications and death in patients with T2D.

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Conflict of interest statement

Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests.

Figures

Figure 1
Figure 1
Numbers of participants in five transitions from baseline to T2D, T2D complications, and all-cause death. The T2D complications involved in this study included diabetic eye diseases, diabetic kidney diseases, diabetic neuropathy diseases, cardiovascular diseases, peripheral vascular diseases, and metabolic events. T2D – type 2 diabetes.
Figure 2
Figure 2
Cumulative transition probabilities of type 2 diabetes for participants with different healthy lifestyle. Computed for age >57 years old men and women in lifestyle score 3–4 points (continuous) and 0–1 point(dotted). The model was adjusted for age, sex, race, body mass index, cancer, high-density lipoprotein, and low-density lipoprotein.
See this image and copyright information in PMC

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