Abstract P344: Trends and Disparities in Lifestyle Quality Among US Adults With Diabetes

Abstract

Introduction: Lifestyle modification is the cornerstone of diabetes management, yet, little is known about trends in overall lifestyle quality among people with diabetes (PWD). Hypothesis: We hypothesized that the lifestyle quality of PWD would be improved and the disparities would be narrowed given the great efforts made in the past two decades. Methods: We conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey to assess national trends in lifestyle quality among PWD from 1999 through 2018. Accordingly, a well-established healthy lifestyle score involving four low-risk factors: never smoking, moderate alcohol consumption (women ≤ 1 drink/day, men ≤ 2 drinks/day), regular physical activity (top third of physical activity), and healthy diet (top two-fifths of healthy eating index 2015) was constructed with the range from 0 to 4. Results: Among 7410 participants included (weighted mean age, 59.8 years; 51.0% men), the estimated mean healthy lifestyle score slightly increased from 1.4 (95% CI: 1.3 to 1.5) in 1999-2002 to 1.6 (1.5 to 1.8) in 2015-2018 (P for trend=0.002). Only 22.0% of PWD reported adhering to 3-4 low-risk lifestyle factors in 2015-2018. During this period, the non-Hispanic Blacks caught up with the non-Hispanic White in overall lifestyle quality (1.7 vs 1.6 in 2015-2018), but large disparities remained by poverty-income ratio, education level, and health insurance status. By 2015-2018, the estimated mean lifestyle score was lower among participants with lower (1.2, 95% CI: 1.0 to 1.3) vs higher income (1.7, 1.6 to 1.8), lower (1.4, 1.3 to 1.5) vs higher education (1.8, 1.7 to 2.0), and among uninsured (1.4, 1.2 to 1.6) vs insured adults (1.7, 1.5 to 1.8). Conclusions: The overall lifestyle quality of US adults with diabetes was far below optimal levels and large socioeconomic disparities remained. The potential for lifestyle improvement remains large and may further facilitate long-term survival among PWD whose metabolic control has plateaued and whose causes of death diversify.