Lifestyle factors and mortality among adults with diabetes: findings from the European Prospective Investigation into Cancer and Nutrition-Potsdam study

Background: Healthy lifestyle behaviors are among the cornerstones of diabetes self-management, but the extent to which healthy lifestyle factors could potentially prevent premature mortality among people with diabetes remains unknown. The aim of the present study was to estimate the reduction in mortality that could be achieved if people with diabetes did not smoke, had a body mass index < 30 kg/m(2), performed physical activity for >= 3.5 h/week, reported better dietary habits, and consumed alcohol moderately. Methods: A prospective cohort study of 1263 German men and women with diabetes aged 35-65 years who were followed for an average of 7.8 years was used and multivariate Cox regression models for all-cause and cause-specific mortality were calculated. Results: Approximately 7% of study participants had no favorable factors, 24% had one, 35% had two, and 34% had three or more. Compared with participants who had no favorable factors, the reduction in risk was 34% [95% confidence interval (CI) 19%, 63%] for those with one favorable factor, 49% (95% CI 9%, 71%) for those with two, and 63% (95% CI 31%, 80%) for those with three or more. Furthermore, a competing risk analysis did not show any difference in the inverse associations with mortality due to cardiovascular disease, cancer, or other causes. Conclusions: Favorable lifestyle factors can potentially achieve substantial reductions in premature mortality among people with diabetes. Our results emphasize the importance of helping people with diabetes optimize their lifestyle behaviors.