Scripties UMCG - Rijksuniversiteit Groningen
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Using composite lifestyle phenotypes to gain insight in lifestyle behavior diabetes related parameters : an explorative study

(2019) Bakema, J.A.

Background: insight in current lifestyle behavior of patients with type 2 diabetes mellitus (T2DM) is needed for a shift towards a more tailored lifestyle management which may improve long term health outcomes. Composite lifestyle phenotypes may help to provide more insight in this behavior.
Aim: we investigate whether it is possible to use composite lifestyle phenotypes to gain more insight in lifestyle behavior. Subsequently we investigate whether these phenotypes are associated with 1. treatment efficacy (HbA1c), 2. the presence of micro- and macrovascular complications and 3. criteria for metabolic syndrome.
Material and methods: we performed an explorative study in 410 patients who were included in DIAbetes and LifEstyle Cohort Twente (DIALECT-1). We defined composite lifestyle phenotypes based on nutrition (derived from the Food Frequency Questionnaire (FFQ)), physical activity (derived from the Short Questionnaire to Assess Health-enhancing physical activity (SQUASH)) and Body Mass Index (BMI). We considered a lifestyle component as “healthy” based on international guidelines and previous findings. We defined four groups of composite lifestyle phenotypes, ranging from no “healthy” components (group 0) to all “healthy” components (group 3).
Results: almost half of all patients were “healthy” for two of the three lifestyle components (group 2), mostly physical activity and nutrition (n=102, 62% of group 2). Group 3, showed a significantly lower HbA1c compared with group 1 (53.9 mmol/mol ± 8.9 versus 59.3 ± 12.9, p=0.014) and a significantly lower amount of insulin units compared with group 0 (58 units [35-87] versus 83 [59-118], p-value=0.043). No significant differences were found in the presence of micro- or macrovascular events between the groups. The percentage of patients who met some of the metabolic syndrome criteria was lower in group 3.
Conclusion: when more lifestyle components were “healthy”, disease management was better (HbA1c and insulin units) and the percentage of patients who met some of the metabolic criteria was lower. However, no differences were found in micro- or macrovascular complications between the four groups. Composite phenotypes can help provide a more tailored lifestyle advice and therefore possibly an improved disease management.

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