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 .
Adherence to healthy lifestyle factors and risk of death in men with diabetes mellitus: The Physicians' Health Study.
BACKGROUND & AIMS The relationship between healthy lifestyle factors and mortality in people with type 2 diabetes is unclear . The purpose of this study was to examine whether healthy lifestyle factors are associated with mortality in people with type 2 diabetes . METHODS We prospect ively studied 1163 men with type 2 diabetes from the Physicians ' Health Study . Lifestyle factors consisted of currently not smoking , moderate drinking ( 1 - 2 drinks/day ) , vigorous exercise ( 1+/week ) , BMI < 25 kg/m2 , and being in the top 2 quintiles of the alternate healthy eating index-2010 ( AHEI-2010 ) . Multivariate Cox regression models were used to estimate hazard ratios ( 95 % confidence intervals ) of mortality . RESULTS At baseline , average age was 69 years and mean follow up was 9 years . About 22 % of study participants had ≤1 healthy lifestyle factor , 37 % had two , 29 % had three , and 12 % had four or more healthy lifestyle factors . An inverse relationship was found between the number of lifestyle factors and total mortality . Compared with participants who had ≤1 healthy lifestyle factor , the risk of death was 42 % ( 95 % CI ; 19%-58 % ) lower for those with two healthy lifestyle factors , 41 % ( 95 % CI ; 18%-58 % ) lower for those with three , and 44 % ( 95 % CI ; 12%-64 % ) lower for those with 4 or more healthy lifestyle factors . CONCLUSION Adherence to modifiable healthy lifestyle factors is associated with a lower risk of death among adult men with type 2 diabetes . Our study emphasizes the importance of educating individuals with diabetes to adhere to healthy lifestyle factors
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 .