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 .
Lifestyle, Glycosylated Hemoglobin A1c, and Survival Among Patients With Stable Ischemic Heart Disease and Diabetes.
BACKGROUND The importance of glycosylated hemoglobin A1c ( A1c ) control as part of comprehensive risk factor management in patients with stable ischemic heart disease ( SIHD ) and diabetes mellitus ( DM ) is controversial . OBJECTIVES The purpose of this study was to determine whether a greater number of controlled risk factors at 1 year , including A1c , affects survival in patients with DM and SIHD . METHODS Of 690 patients with DM followed in the COURAGE ( Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation ) trial , 592 ( 86 % ) had complete ascertainment of 7 pre-specified risk factors at baseline and after 1 year : systolic blood pressure , low-density lipoprotein cholesterol , nonsmoking , physical activity , diet adherence , body mass index , and A1c . The primary outcome measure was mortality beyond 1 year after r and omization . RESULTS During a mean follow-up of 7.0 ± 4.2 years beyond 1 year after r and omization , 186 subjects  died ( 31.4 % overall , 4.5%/year ) . The greater the number of risk factors controlled at 1 year , the higher the probability of survival ( unadjusted log rank p = 0.002 ) . Compared with 0 to 1 controlled risk factors , attaining 3 to 7 goals predicted progressively lower mortality ( hazard ratio for control of 6 or 7 risk factors was 0.13 ; 95 % confidence interval : 0.05 to 0.40 ) . Importantly , only 10.3 % of subjects achieved control of 6 or 7 risk factors . In multivariate analysis , the strongest predictors of improved survival were no smoking , regular physical activity , dietary adherence , and A1c < 7 % . CONCLUSIONS In this high-risk subset of SIHD patients with DM , the number of controlled risk factors , particularly lifestyle behaviors and A1c , were associated with improved survival . ( Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation ; NCT00007657 )
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 .