Type 2 diabetes is a metabolic disorder of insulin resistance — a reduced sensitivity to the action of insulin — which leads to high blood sugar, or hyperglycaemia. Approximately 12% of American adults have type 2 diabetes, and more than one-third of Americans have prediabetes, a precursor to type 2 diabetes. This is a major public health concern, as type 2 diabetes dramatically increases risk for heart disease, including heart attacks, atrial fibrillation, and heart failure.
The development and progression of type 2 diabetes is affected by many factors. Some, such as a person’s race/ethnicity, age, and gender cannot be modified. Others, including body weight, exercise, and diet can be changed.
Can lifestyle changes help reduce heart disease risk if you have diabetes?
In 2010, the American Heart Association (AHA) published “Life’s Simple 7,” which it defined as “seven risk factors that people can improve through lifestyle changes to help achieve ideal cardiovascular health.” The Simple 7 touched on smoking status, physical activity, ideal body weight, intake of fresh fruits and vegetables, blood sugar, cholesterol levels, and blood pressure.
Subsequent studies found that people in optimal ranges for each of these factors had lower risks of heart disease compared to people in poor ranges. But given the significant increase in heart disease risk in those with type 2 diabetes, it was not clear if the impact of these modifiable factors would hold true for the type 2 diabetes population.
Recent study suggests lifestyle changes do benefit type 2 diabetes and prediabetes
A study published in JAMA Cardiology looked at whether the ideal cardiovascular metrics covered in Life’s Simple 7 translate into improved cardiovascular health for those with type 2 diabetes or prediabetes. The results were exciting and consistent with other large population-based studies. Patients who had five or more ideal cardiovascular measures had no excess of cardiovascular events compared with people with normal blood sugar levels. Cardiovascular events measured in the study included death, heart attack, stroke, and heart failure. Each additional ideal health metric was associated with an additional 18% drop in cardiovascular event risk for people with type 2 diabetes and an additional 15% drop for those with prediabetes.
This was a prospective, observational study, examining the association of risk factors only. It was not a randomized trial looking at an intervention. As a result, we cannot draw conclusions about cause and effect. Nonetheless, this is the first study to show a positive association between ideal lifestyle factors and cardiovascular health in people who are at high risk for cardiovascular disease due to type 2 diabetes. These results showcase the importance of our lifestyle choices, suggesting that meeting ideal health metrics can help reduce risk of cardiovascular events.
Life’s Simple 7
So what are the lifestyle and metabolic health goals should you strive for, whether or not you have diabetes?
- Manage blood pressure. 120/80 mm Hg or lower is best.
- Control cholesterol. Aim for total cholesterol below 200 mg/dL.
- Reduce blood sugar. Get your HbA1c (an average measure of blood sugar over the past three months) under 5.7% if you have prediabetes, or below 6.5% if you have type 2 diabetes.
- Get active. Your goal is 150 minutes per week of moderate-intensity activity or 75 minutes per week of vigorous activity.
- Eat better. That means at least 4.5 cups of fruits and vegetables per day.
- Lose weight. You want a body mass index (BMI) of less than 25.
- Stop smoking. You’ll reap cardiovascular benefits, not to mention lowering your risk for cancer, COPD, and much more.
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