Published: Oct 14, 2013 | Updated: Oct 15, 2013<
By Salynn Boyles

Full Story:  http://www.medpagetoday.com/Endocrinology/Diabetes/42251

There should be little difference between the lifestyle advice given to diabetics and that given to the general public, results of a large, prospective study suggested.

Although diabetics in the study had a 62% higher risk of dying than people without a diabetes diagnosis, diabetes status did not substantially influence the associations between lifestyle and mortality risk, researcher Diewertje Sluik, MSc, ofWageningen University in the Netherlands, and colleagues, wrote online in Diabetologia.

Using a competing risk model to quantify and test for differences in epidemiological associations between diabetics and nondiabetics, the researchers were able to assess the impact of BMI, waist/hip ratio, alcohol consumption, smoking, exercise, and 26 food groups on death risk.

Intake of fruit, legumes, nuts, seeds, pasta, poultry, and vegetable oil was associated with lower mortality in the diabetics, while intake of butter and margarine were associated with higher mortality.

“These associations were significantly different in magnitude from those in diabetes-free individuals, but the directions were similar,” the researchers wrote. “No differences between people with and without diabetes were detected for other lifestyle factors.”

Along with drug treatments, lifestyle modification is a cornerstone of diabetes treatment. Patients are advised to lose weight or maintain a healthy body weight, exercise regularly, limit alcohol consumption, avoid smoking, and eat a healthy diet, but Sluik and colleagues wrote that “the evidence supporting these recommendations has rarely been derived from studies of people with diabetes.”

Their own previous research in diabetic patients found that measures of abdominal adiposity, but not general adiposity, were associated with higher mortality, and those who exercised regularly had a lower risk of death.

The main objective of their latest study was to investigate whether lifestyle recommendations for diabetics should differ from those given to the general public.

The study included close to 260,000 people without a diagnosis of diabetes and 6,384 people with a diabetes diagnosis enrolled in a large, prospective study that included 10 European countries.

The participants’ weight, height, and waist circumference were measured at baseline, and dietary intake during the previous year was assessed through dietary questionnaires that included 300 to 500 items, as well as food frequency questionnaires and combined dietary methods of food records and questionnaires. Other questionnaires were used to assess exercise and alcohol consumption frequency.

After a median follow-up of almost 10 years, 830 of those with diabetes (13%) and 12,135 nondiabetics (5%) had died.

Joint Cox proportional hazard regression modeling was used to evaluate the impact of individual lifestyle and dietary components on mortality.

Among the findings:

• Higher butter and margarine consumption was associated with increased mortality in those with diabetes (HR 1.05, 95% CI 1.02-1.09, P=0.004), but this was not the case with nondiabetics (HR 1.00, 95% CI 0.99-1.02).
• Compared with light alcohol consumption (up to 6 grams a day), abstinence and high consumption (more than 60 grams a day) was associated with increased mortality risk. However, moderate drinking (6-60 g/day) was associated with a lower risk of death in nondiabetics, but not in those with diabetes. This risk was not statistically significant for either abstainers (P=0.41) or heavy drinkers (P=0.86).

“This study suggests that, with respect to mortality, lifestyle advice for people with diabetes should not differ from the existing recommendations for the general population,” the researchers wrote. “It may be that those with diabetes benefit more from a healthy diet than diabetes-free individuals. However, this has to be confirmed in further studies.”