Lifestyle Behaviors to Reduce Risk for Type 2 Diabetes

Identifying the lifestyle behaviors that can reduce risk for type 2 diabetes in individuals considered low-risk.

Lifestyle modifications, like structured dietary regimens and physical activity, are utilized to delay the progression of type 2 diabetes mellitus (T2DM). Many studies have been performed in high risk populations, but none to date have been performed in a population deemed low risk for T2DM.

In a cross-sectional study, data was obtained from the National Health and Nutrition Examination Surveys during 2007-2012. They focused on 3,679 U.S. adults aged ≥ 20 years who are not-pregnant, not-lactating and do not have diabetes. Lifestyle variables analyzed included dietary goals, physical activity goals, and weight loss/maintenance goals. Dietary goals were derived from U.S. Diabetes Prevention Program (DPP), USDA MyPlate guidelines, and National Cholesterol Education Program (NCEP), while physical activity and weight loss goals were taken from the DPP. Demographic data and number of subjects meeting goals were also analyzed.

Demographic data was analyzed by weighted proportions and means of SE, while multivariable logistic regression was used to determine if subjects met ≥50% dietary and physical activity lifestyle goals. Dietary and physical activity lifestyle goals data was presented as a percentage of adults meeting dietary and physical activity goals without surpassing maximum allotments for solid fats, alcohol, added sugar, total fat, and cholesterol.

Summary of Results:

Result	Prediabetic U.S. Population	Non-diabetic U.S. Population
Demographic	Male, older, predominantly non-Hispanic white, less than a college education, overweight/obese, higher percentage of smoking	Fewer male, younger, predominantly non-Hispanic white, more with some college education, normal/overweight, fewer smokers
MyPlate & Physical Activity	31.7% met goal recommendations (p<0.001)	42.3% met goal recommendations (p<0.001)
Weight Loss	49.9% met goal recommendation (p<0.001)	63.8% met goal recommendation (p<0.001)
Consumption Under Maximum Allowances	In both populations, a small percentage maintained appropriate allowances for added sugars (24.1%), saturated fat (42.7%), and total fat (33.7%). Most did not exceed cholesterol requirements and a majority (~90%) maintained appropriate alcohol use.

In assessing the number meeting the T2DM prevention goals, 3.1% (95% CI 2.4-4.0) of adults without diabetes met most risk reduction goals, 0.44 (95% CI 0.28-0.70, p = 0.002) of adults aged 20-44 years were unlikely to reach risk reduction goals, and 0.27 [0.14-0.530, p < 0.001) of adults with less than a high school education were unlikely to reach risk reduction goals compared to those with college education.

Previous studies, like the Finnish Diabetes Prevention Study, have shown that reaching a higher number of prevention goals is correlated with reduction in T2DM incidence. Overall, while lifestyle modifications are the most effective method of reducing T2DM risk, most Americans do not abide by this. During the duration of the study, 2007-2012, only 3.1% of U.S. adults without diabetes implemented these strategies. Furthermore, those younger and less educated were 56-73% less likely to meet goals, indicating a strong need for more dietary and lifestyle education. Lastly, those without diabetes were found to reach physical activity and weight loss goals better than those who had prediabetes, but overall dietary goals were less likely to be achieved. This finding may suggest that pinpointing problematic behaviors — those difficult to adhere to — may prove useful in achieving dietary and physical activity goals.

Overall, the study corroborates existing information, that Americans continue to struggle with healthy eating habits and continued efforts must be made to help healthy lifestyles be more doable.The sooner healthy habits and lifestyle modification can be implemented, in both high and low risk populations, the better.

Practice Pearls:

• Several lifestyle behaviors have been identified and are essential in individuals deemed low risk (i.e. without diabetes and prediabetes). They include: 1) maintaining a proper diet, 2) performing regular physical activity, 3) achieving weight  goals/maintenance, 4) avoiding consuming maximum quantities of added sugars, fat, and alcohol.
• Individuals without diabetes often reach physical activity and weight goals, but struggle to achieve dietary goals.
• Only 3.1% of U.S. adults without diabetes or with prediabetes engage in T2DM risk-reducing behaviors.

Kaytie A. Weierstahl, Pharm.D. Candidate, LECOM School of Pharmacy

Siegel, K., Bullard, K., Imperatore, G., Ali, M., Albright, A., Mercado, C., Li, R., and Gregg, E. Prevalence of Major Behavioral Risk Factors for Type 2 Diabetes. Diabetes Care 41.5 (2018): 1032-1039. https://care.diabetesjournals.org/. 5 May 2018.