Abstract
BackgroundLarge 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.MethodsAmong 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.ResultsDecreasing 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].ConclusionsIn 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
Highlights
Large changes in health behaviors achieved through intensive lifestyle intervention programs improve cardiovascular disease (CVD) risk factors among adults with type 2 diabetes
In the Action for Health in Diabetes (Look AHEAD) trial, > 2 metabolic equivalent (MET) increases in physical fitness were associated with improvements in haemoglobin A1c (HbA1c), highdensity lipoprotein (HDL) and triglycerides [8], there were no apparent associations with CVD incidence [9]
In the ADDITIONCambridge study, we showed that participants who increased physical activity or decreased alcohol consumption in the year following diabetes diagnosis had lower 5-year hazard of CVD, and the total number of healthy behavior changes had a protective association with CVD [11]
Summary
Large changes in health behaviors achieved through intensive lifestyle intervention programs improve cardiovascular disease (CVD) risk factors among adults with type 2 diabetes. Such interventions are not widely available, and there is limited evidence as to whether changes in behaviors affect risk of CVD events. Despite the fact that changes in diet, physical activity, smoking and alcohol use are recognized as a cornerstone of type 2 diabetes treatment [2], there is limited evidence as to whether changes in these behaviors affect risk of cardiovascular disease (CVD) events. Results from selective trial cohorts may not be generalizable to broader patient populations, and behavior changes achieved in such trials may not be realistic in the absence of a costly specialistled intervention
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