Changes in behaviors after diagnosis of type 2 diabetes and 10-year incidence of cardiovascular disease and mortality

Abstract

Background Large changes in health behaviors achieved through intensive lifestyle intervention programs improve cardiovascular disease (CVD) risk factors among adults with type 2 diabetes. However, such interventions are not widely available, and there is limited evidence as to whether changes in behaviors affect risk of CVD events. Methods Among 852 adults with screen-detected type 2 diabetes in the ADDITION - Cambridge study, we assessed changes in diet, physical activity, and alcohol use in the year following diabetes diagnosis. Participants were recruited from 49 general practices in Eastern England from 2002 to 2006, and were followed through 2014 for incidence of CVD events (n = 116) and all-cause mortality (n = 127). We used Cox proportional hazards regression to estimate hazard ratios (HR) for the associations of changes in behaviors with CVD and all-cause mortality. We estimated associations with CVD risk factors using linear regression. We considered changes in individual behaviors and overall number of healthy changes. Models adjusted for demographic factors, bodyweight, smoking, baseline value of the health behavior, and cardio-protective medication use. Results Decreasing alcohol intake by ≥ 2 units/week was associated with lower hazard of CVD vs maintenance [HR: 0.56, 95% CI 0.36, 0.87]. Decreasing daily calorie intake by ≥ 300 kcal was associated with lower hazard of all-cause mortality vs maintenance [HR: 0.56, 95% CI 0.34, 0.92]. Achieving ≥ 2 healthy behavior changes was associated with lower hazard of CVD vs no healthy changes [HR: 0.39, 95% CI 0.18, 0.82]. Conclusions In the year following diabetes diagnosis, small reductions in alcohol use were associated with lower hazard of CVD and small reductions in calorie intake were associated with lower hazard of all-cause mortality in a population-based sample. Where insufficient resources exist for specialist-led interventions, achievement of moderate behavior change targets is possible outside of treatment programs and may reduce long-term risk of CVD complications. Trial registration This trial is registered as ISRCTN86769081. Retrospectively registered 15 December 2006 Electronic supplementary material The online version of this article (10.1186/s12933-019-0902-5) contains supplementary material, which is available to authorized users.

Association of weight loss and weight loss maintenance following diabetes diagnosis by screening and incidence of cardiovascular disease and all‐cause mortality: An observational analysis of the ADDITION‐Europe trial

“…Information on intention to lose weight is not available in the ADDITION study, but among Cambridge participants only (N = 867), we collected questionnaire data on health behaviours. We previously showed that reductions in alcohol use and total calorie intake were associated with the lower 10‐year hazard of CVD, 22 but participants who made these changes did not necessarily lose weight. We did not count deaths during the year after weight change was assessed to reduce the chance of confounding by unintentional weight loss.…”

Association between the Mediterranean lifestyle, metabolic syndrome and mortality: a whole-country cohort in Spain

“…Several studies evaluating other lifestyle scores like the American Heart Association Life Simple 7, that includes 4 lifestyle behaviors (BMI, smoking, diet, physical activity) and 3 clinical risk factors (blood pressure, high cholesterol, and diabetes) have found important inverse associations with CVD and total-mortality in different cohorts [ 63 – 68 ]. In addition, reductions in alcohol intake and energy intake over 1 year in participants with diabetes diagnosis was association with lower hazard of CVD [ 69 ]. However, the effect of behavioral factors may be attenuated after the development of the clinical risk factors which are associated with CVD.…”

Patterns of Alcohol Consumption in the PURE Poland Cohort Study and Their Relationship with Health Problems

“…On the other hand, a reduction in the risk of type 2 diabetes was observed in women (peak reduction at the level of consumption of 31–37 g of alcohol per day) [ 42 ]. Having said that, it was observed that among the patients with diagnosed diabetes, limiting alcohol consumption by at least 2 units/week decreased a 10-year risk of CVD (HR: 0.56, 95% CI 0.36, 0.87) [ 43 ]. Alcohol consumption is also a well-known risk factor for hypertension [ 44 , 45 , 46 ].…”