Article Text

Download PDFPDF
Adherence to healthy lifestyles and incidence of diabetes and mortality among individuals with diabetes: a systematic review and meta-analysis of prospective studies
  1. Sabrina Schlesinger1,
  2. Manuela Neuenschwander1,
  3. Aurélie Ballon1,
  4. Ute Nöthlings2,
  5. Janett Barbaresko1
  1. 1 Institute for Biometrics and Epidemiology, German Diabetes Center, Düsseldorf, Germany
  2. 2 Department of Nutrition and Food Sciences, University of Bonn, Bonn, Germany
  1. Correspondence to Dr Sabrina Schlesinger, Institute for Biometrics and Epidemiology, German Diabetes Center, Düsseldorf 40225, Germany; sabrina.schlesinger{at}


Introduction Lifestyle factors in combination have been hypothesised to be associated with the prevention of type 2 diabetes (T2D) and mortality among individuals with T2D. The aim was to conduct a systematic review and meta-analysis to quantify the association between lifestyle indices and incident T2D as well as mortality in individuals with T2D.

Methods PubMed and Web of Science were searched up to September 2019. We included prospective cohort studies investigating at least three lifestyle factors in association with T2D, or all-cause mortality in individuals with diabetes. We conducted pairwise and dose-response meta-analyses to calculate summary relative risks (SRR) by using random effects model.

Results In total, 19 studies were included. Adhering to a healthy lifestyle (mostly favourable diet, physical activity, non-smoking, moderate alcohol intake and normal weight) was associated with a reduced SRR of 78% for T2D (SRR: 0.22; 95% CI: 0.16 to 0.32; n=14) and 57% for mortality (SRR: 0.43; 95% CI: 0.31 to 0.58; n=5) compared with low adherence to a healthy lifestyle. In dose-response analyses, the adherence to every additional healthy lifestyle factor was associated with a reduced relative risk of 32% (95% CI: 28% to 36%) for T2D and 21% (95% CI: 15% to 26%) for mortality.

Conclusions Our findings underline the importance of the joint adherence to healthy lifestyle factors to prevent T2D and improve survival among individuals with diabetes. Adherence to every additional health lifestyle factor play a role in the T2D prevention and progression.

PROSPERO registration number CRD42018091409.

  • diabetes
  • lifestyle
  • systematic reviews
  • mortality
  • Meta-analysis

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors SS and JB designed the study question, conducted the literature screening, conducted the analyses and wrote the first draft of the paper. AB, MN and JB extracted the data. MN and JB assessed the risk of bias of included studies. SS and JB taking responsibility for the contents of the article. SS, MN, AB, UN and JB interpreted the data, critically reviewed the manuscript and approved submission of the final manuscript.

  • Funding The German Diabetes Centre is funded by the German Federal Ministry of Health and the Ministry of Innovation, Science and Research of the State of North Rhine-Westphalia. This work was supported as part of a project investigating diabetes complications (Sondertatbestand ‘Begleit- und Folgeerkrankungen des Diabetes’).

  • Disclaimer The study sponsors had no role in study design; collection, analysis and interpretation of data; writing the report and the decision to submit the report for publication.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.