Lifestyle Risk Factors and New-Onset Diabetes Mellitus in Older Adults

Abstract

Given medical challenges, health care costs, long-term complications, and growing incidence and prevalence of type 2 diabetes mellitus, preventing the onset of clinical diabetes is of paramount importance. Long-term treatment with drugs such as metformin may prevent or delay onset of diabetes among specific high-risk subgroups.¹ Modest changes in diet and exercise also prevent onset of diabetes in these high-risk subgroups, to a greater extent than metformin^1,2; improve a broad range of other metabolic risk factors that are largely unaffected by metformin³; and may be more applicable to a broader population than long-term drug treatment. Lifestyle factors linked to incidence of diabetes or diabetes-related risk factors include physical activity level, dietary habits, adiposity, alcohol use, and smoking habits.^4-15 In secondary analyses from the Diabetes Prevention Program trial, structured advice on diet and activity was most effective at reducing diabetes risk among the oldest participants (60-85 years),¹⁶ which suggests that lifestyle habits might be particularly important, rather than less effective, for preventing diabetes later in life. However, this was a post hoc analysis of a trial with high-risk participants (overweight or obese individuals having both elevated fasting glucose and elevated 2-hour postchallenge glucose levels) who were also participating in a highly structured intervention; therefore, applicability of these results to a broader population of older adults is unclear. In addition, effects on diabetes risk from smoking habits and alcohol use were not evaluated in this trial.