HealthDay News — Lifestyle advice for patients with diabetes should be similar to that given to people without diabetes, results of a large, prospective study suggest.

Adjusted mortality among individuals with diabetes is higher than those without the condition, with a hazard ratio of 1.62, but diabetes status did not substantially influence the associations between lifestyle and mortality risk, Diewertje Sluik, PhD, from the German Institute of Human Nutrition in Nuthetal, and colleagues reported in   Diabetologia.

The researchers assessed the impact of BMI, waist/hip ratio, alcohol consumption, smoking, exercise, and intake of 26 food groups on death risk using a competing risk model to determine differences in epidemiological associations between diabetics and nondiabetics.

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Among patients with diabetes there was a lower mortality associated with intake of fruit, legumes, nuts, seeds, pasta, poultry and vegetable oil, while intake of butter and margarine was related to an increased mortality risk. The magnitude of these associations significantly differed from those in diabetes-free individuals, but directions were similar. There were no other differences in lifestyle factors between the two groups.

“Diabetes status did not substantially influence the associations between lifestyle and mortality risk,” the researchers wrote.

The analysis involved 6,384 people with diabetes and 258,911 people without known diabetes who participated in the European Prospective Investigation into Cancer and Nutrition study. 

Participants’ weight, height and waist circumference were measured at baseline, and dietary intake during the previous year was assessed through dietary questionnaires that included 300 to 500 items, as well as food frequency questionnaires and combined dietary methods of food records and questionnaires. Other questionnaires were used to assess exercise and alcohol consumption frequency. 

During median 10-year follow-up 830 participants with diabetes (13%) and 12,135 of those without the condition (5%) died. 

Key study findings include:

  • Higher butter and margarine consumption was associated with increased mortality in those with diabetes (HR 1.05; 95% CI: 1.02-1.09; P=0.004), but not in those without diabetes (HR 1.00; 95% CI: 0.99-1.02).
  • Compared with light alcohol consumption (up to 6 grams a day), abstinence and high consumption (more than 60 grams a day) was associated with lower mortality risk in patients without diabetes, but not in those with diabetes. This risk was not statistically significant for either abstainers (P=0.41) or heavy drinkers (P=0.86).
  • Higher amounts of leisure-time physical activity were related to lower mortality rates in both groups, but the differences were not statistically significant.
  • Current smokers had an increased mortality risk compared with never smokers regardless of diabetes status (in patients with diabetes HR 2.29; 95% CI:1.91-3.01; for those without diabetes HR 2.27; 95% CI: 2.17-2.38, P=0.26).

“This study suggests that, with respect to mortality, lifestyle advice for people with diabetes should not differ from the existing recommendations for the general population,” the researchers wrote. “It may be that those with diabetes benefit more from a healthy diet than diabetes-free individuals. However, this has to be confirmed in further studies.”


  1. Sluik D et al. Diabetolgia. 2013; doi: 10.1007/s00125-013-3074-y.