Healthy lifestyle behaviors, mediating biomarkers, and risk of microvascular complications among individuals with type 2 diabetes: A cohort study

• Published in: PLoS medicine 2023-01, Vol.20 (1), p.e1004135-e1004135
• Main Authors: Geng, Tingting, Zhu, Kai, Lu, Qi, Wan, Zhenzhen, Chen, Xue, Liu, Liegang, Pan, An, Liu, Gang
• Format: Article
• Language: English
• Subjects: Alcohol use; Analysis; Apolipoprotein A; Apolipoproteins; Biobanks; Biological markers; Biology and Life Sciences; Biomarkers; Blood circulation disorders; Blood pressure; Body mass index; C-reactive protein; Cholesterol; Cohort analysis; Cohort Studies; Complications and side effects; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - epidemiology; Diabetic Nephropathies; Diabetic Neuropathies - complications; Diabetic neuropathy; Diabetic Retinopathy; Diet; Drinking behavior; Electronic medical records; Epidemiology; Health aspects; Health behavior; Health care; Healthy Lifestyle; High density lipoprotein; Humans; Kidney diseases; Kidneys; Life style; Lifestyles; Lipoproteins; Medicine and Health Sciences; Metabolism; Microvasculature; Neuropathy; Obesity; Physical activity; Public health; Retinopathy; Retrospective Studies; Risk Factors; Social Sciences; Triglycerides; Type 2 diabetes; Variables; Womens health
• ISSN: 1549-1676; 1549-1277; 1549-1676
• DOI: 10.1371/journal.pmed.1004135

The influence of overall lifestyle behaviors on diabetic microvascular complications remains unknown. In addition, the potential mediating biomarkers underlying the association is unclear. This study aimed to examine the associations of the combined lifestyle factors with risks of total and individual microvascular complications among patients with type 2 diabetes (T2D) and to explore the potential mediation effects of metabolic biomarkers. This retrospective cohort study included 15,104 patients with T2D free of macro- and microvascular complications at baseline (2006 to 2010) from the UK Biobank. Healthy lifestyle behaviors included noncurrent smoking, recommended waist circumference, regular physical activity, healthy diet, and moderate alcohol drinking. Outcomes were ascertained using electronic health records. Over a median of 8.1 years of follow-up, 1,296 cases of the composite microvascular complications occurred, including 558 diabetic retinopathy, 625 diabetic kidney disease, and 315 diabetic neuropathy, with some patients having 2 or 3 microvascular complications simultaneously. After multivariable adjustment for sociodemographic characteristics, history of hypertension, glycemic control, and medication histories, the hazard ratios (95% confidence intervals (CIs)) for the participants adhering 4 to 5 low-risk lifestyle behaviors versus 0 to 1 were 0.65 (0.46, 0.91) for diabetic retinopathy, 0.43 (0.30, 0.61) for diabetic kidney disease, 0.46 (0.29, 0.74) for diabetic neuropathy, and 0.54 (0.43, 0.68) for the composite outcome (all Ps-trend ≤0.01). Further, the population-attributable fraction (95% CIs) of diabetic microvascular complications for poor adherence to the overall healthy lifestyle (