Type 2 diabetes (T2D) is a metabolic disorder of insulin resistance — a reduced sensitivity to the action of insulin — which leads to high blood sugar, or hyperglycemia. Approximately 12% of American adults have T2D, and more than one-third of Americans have prediabetes, a precursor to T2D. This is a major public health concern, as T2D dramatically increases risk for heart disease, including heart attacks, atrial fibrillation, and heart failure.
The development and progression of T2D 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 they 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 T2D, it was not clear if the impact of these modifiable factors would hold true for the T2D population.
Recent study suggests lifestyle changes do benefit T2D and prediabetes
A recent study published in JAMA Cardiology looked at whether the ideal cardiovascular (CV) metrics covered in Life’s Simple 7 translate into improved CV health for those with T2D or prediabetes. The results were exciting, and consistent with other large population-based studies. Patients who had five or more ideal CV measures had no excess of CV events compared with people with normal blood sugar levels. CV 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 CV event risk for people with T2D, 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 CV health in people who are at high risk for CVD due to T2D. These results showcase the importance of our lifestyle choices, suggesting that meeting ideal health metrics can help reduce risk of CV 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 T2D.
- 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 CV benefits, not to mention lowering your risk for cancer, COPD, and much more.
Bible verses for today’s meditation and inspiration: Matthew E. McLaren
Philippians 3:1-21 Finally, my brothers, rejoice in the Lord. To write the same things to you is no trouble to me and is safe for you. Look out for the dogs, look out for the evildoers, look out for those who mutilate the flesh. For we are the circumcision, who worship by the Spirit of God and glory in Christ Jesus and put no confidence in the flesh— though I myself have reason for confidence in the flesh also. If anyone else thinks he has reason for confidence in the flesh, I have more: circumcised on the eighth day, of the people of Israel, of the tribe of Benjamin, a Hebrew of Hebrews; as to the law, a Pharisee; …
2 Corinthians 13:11 Finally, brothers, rejoice. Aim for restoration, comfort one another, agree with one another, live in peace; and the God of love and peace will be with you.
Galatians 6:1-18 Brothers, if anyone is caught in any transgression, you who are spiritual should restore him in a spirit of gentleness. Keep watch on yourself, lest you too be tempted. Bear one another’s burdens, and so fulfill the law of Christ. For if anyone thinks he is something, when he is nothing, he deceives himself. But let each one test his own work, and then his reason to boast will be in himself alone and not in his neighbor. For each will have to bear his own load. …
Genesis 2:1-25 Thus the heavens and the earth were finished, and all the host of them. And on the seventh day God finished his work that he had done, and he rested on the seventh day from all his work that he had done. So God blessed the seventh day and made it holy, because on it God rested from all his work that he had done in creation. These are the generations of the heavens and the earth when they were created, in the day that the LORD God made the earth and the heavens. When no bush of the field was yet in the land and no small plant of the field had yet sprung up—for the LORD God had not caused it to rain on the land, and there was no man to work the ground, …
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