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Lifestyle intervention logical route in reducing type 2 diabetes risk
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The role of genetic factors in the onset of type 2 diabetes is strongest in younger and leaner people who are not at very high risk for the condition, but obesity still carries a higher absolute risk for progression to type 2 diabetes, according to research published in PLOS Medicine, suggesting lifestyle interventions as the logical target for universal prevention.
In the InterAct study — an analysis of 12,403 incident type 2 diabetes cases and a representative subcohort of 16,154 individuals from 340,234 European participants followed for nearly 12 years — Claudia Langenberg, MD, PhD, of the Medical Research Council Epidemiology Unit, University of Cambridge, United Kingdom, and colleagues examined genetics vs. lifestyle in influencing the condition.
Claudia Langenberg
The researchers quantified the combined effects of an additive genetic type 2 diabetes risk score and modifiable and non-modifiable risk factors through Prentice-weighted Cox regression and random-effects meta-analysis methods.
In younger individuals, the effect of the genetic score was significantly higher (P for interaction=1.2×10−4). For those who were leaner, relative genetic risk per standard deviation was also greater for BMI (P for interaction=1.5×10−3) and waist circumference (P for interaction=7.49×10−9).
The absolute risks examined by strata showed the effect of obesity on type 2 diabetes risk. Over 10 years, cumulative incidence rose from 0.25% to 0.89% across extreme quartiles of the genetic score in individuals with normal weight vs. 4.22% to 7.99% in those with obesity.
“The high absolute risk associated with obesity at any level of genetic risk highlights the importance of universal rather than targeted approaches to lifestyle intervention,” the researchers wrote.
Disclosure: One of the researchers owns stock in GlaxoSmithKline and Incyte. Two are members of the PLOS Medicine Editorial Board. Please see study for a full list of funding disclosures.
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