Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. In this systematic review and meta-analysis, maximum adherence to the combination of five low-risk lifestyle behaviors (LRLBs) was associated with an 85% lower risk of type 2 diabetes (T2DM).

2. In addition, when comparing those who had the highest adherence versus those with the lowest adherence to these behaviors, the difference in risk was up to 80%.

Evidence Rating Level: 1 (Excellent)

Lifestyle modifications with the incorporation of low-risk lifestyle behaviors (LRLBs), including exercising, eating a healthy diet, and reducing substance use, have been a mainstay for type 2 diabetes (T2DM) management. Currently, no review has synthesized the cumulative effect of these behaviors on incident T2DM. As a result, the objective of the present systematic review and meta-analysis was to evaluate the association between adherence to LRLBs and incident T2DM.

Of 6987 identified records, 19 (n=1,693,753 participants, median age 54) studies were included from various databases from inception to September 2022. Studies were included if they were prospective cohort studies evaluating the effect of LRLBs on incident T2DM with a minimum of 1-year follow-up. Clinical trials and cohort studies that did not report diet and/or combined lifestyle behaviors were excluded. The review was performed using PRISMA guidelines. Study quality was assessed using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). The risk of bias was assessed using a funnel plot and Egger and Begg tests. The primary outcome was incident T2DM.

The results demonstrated that patients who exhibited maximum adherence to five LRLBs, including maintaining a healthy body weight, healthy diet, regular exercise, smoking cessation/abstinence, and light alcohol consumption, had 85% protection against incident T2DM. In addition, those who adhered to the maximum combination of LRLB’s had up to an 80% difference in incidence compared to those who adhered to 0-3 LRLBs. Despite this, the review was limited by the heterogeneity of the included studies, which may have affected the results. Nonetheless, the present study presented strong evidence that adherence to multiple LRLBs may significantly reduce the risk of incident T2DM.

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