The associations were largely consistent and significant among individuals from different socioeconomic background s and baseline characteristics .
Conclusions /interpretationAdoption of a healthy lifestyle is associated with substantial risk reduction in type 2 diabetes and long-term adverse outcomes among diabetic individuals .
Aims /hypothesisA healthy lifestyle has been widely recommended for the prevention and management of type 2 diabetes .
However , no systematic review has summarised the relationship between combined lifestyle factors ( including , but not limited to , smoking , alcohol drinking , physical activity , diet and being overweight or obese ) and  incident type 2 diabetes and risk of health outcomes among diabetic individuals .
Morbidity and mortality after lifestyle intervention for people with impaired glucose tolerance: 30-year results of the Da Qing Diabetes Prevention Outcome Study.
BACKGROUND Lifestyle interventions can delay the onset of type 2 diabetes in people with impaired glucose tolerance , but whether this leads subsequently to fewer complications or to increased longevity is uncertain . We aim ed to assess the long-term effects of lifestyle interventions in people with impaired glucose tolerance on the incidence of diabetes , its complications , and mortality . METHODS The original study was a cluster r and omised trial , started in 1986 , in which 33 clinics in Da Qing , China , were r and omly assigned to either be a control clinic or provide one of three interventions ( diet , exercise , or diet plus exercise ) for 6 years for 577 adults with impaired glucose tolerance who usually receive their medical care from the clinics . Subsequently , participants were followed for up to 30 years to assess the effects of intervention on the incidence of diabetes , cardiovascular disease events , composite microvascular complications , cardiovascular disease death , all-cause mortality , and life expectancy . FINDINGS Of the 577 participants , 438 were assigned to an intervention group and 138 to the control group  ( one refused baseline examination ) . After 30 years of follow-up , 540 ( 94 % ) of 576 participants were assessed for outcomes ( 135 in the control group , 405 in the intervention group ) . During the 30-year follow-up , compared with control , the combined intervention group had a median delay in diabetes onset of 3·96 years ( 95 % CI 1·25 to 6·67 ; p=0·0042 ) , fewer cardiovascular disease events ( hazard ratio 0·74 , 95 % CI 0·59 - 0·92 ; p=0·0060 ) , a lower incidence of microvascular complications ( 0·65 , 0·45 - 0·95 ; p=0·025 ) , fewer cardiovascular disease deaths ( 0·67 , 0·48 - 0·94 ; p=0·022 ) , fewer all-cause deaths ( 0·74 , 0·61 - 0·89 ; p=0·0015 ) , and an average increase in life expectancy of 1·44 years ( 95 % CI 0·20 - 2·68 ; p=0·023 ) . INTERPRETATION Lifestyle intervention in people with impaired glucose tolerance delayed the onset of type 2 diabetes and reduced the incidence of cardiovascular events , microvascular complications , and cardiovascular and all-cause mortality , and increased life expectancy . These findings provide strong justification to continue to implement and exp and the use of such interventions to curb the global epidemic of type 2 diabetes and its consequences . FUNDING US Centers for Disease Control and Prevention , WHO , Chinese Center for Disease Control and Prevention , World Bank , Ministry of Public Health of the People 's Republic of China , Da Qing First Hospital , China-Japan Friendship Hospital , and National Center for Cardiovascular Diseases & Fuwai Hospital
The associations were largely consistent and significant among individuals from different socioeconomic background s and baseline characteristics .
Conclusions /interpretationAdoption of a healthy lifestyle is associated with substantial risk reduction in type 2 diabetes and long-term adverse outcomes among diabetic individuals .
Aims /hypothesisA healthy lifestyle has been widely recommended for the prevention and management of type 2 diabetes .
However , no systematic review has summarised the relationship between combined lifestyle factors ( including , but not limited to , smoking , alcohol drinking , physical activity , diet and being overweight or obese ) and  incident type 2 diabetes and risk of health outcomes among diabetic individuals .