Association of healthy lifestyle including a healthy sleep pattern with incident type 2 diabetes mellitus among individuals with hypertension

Abstract

Background: Evidence is limited regarding the association of healthy lifestyle including sleep pattern with the risk of complicated type 2 diabetes mellitus (T2DM) among patients with hypertension. We aimed to investigate the associations of an overall healthy lifestyle including a healthy sleep pattern with subsequent development of T2DM among participants with hypertension compared to normotension, and to estimate how much of that risk could be prevented.

Methods: This study examined six lifestyle factors with T2DM cases among hypertension (227,966) and normotension (203,005) and their interaction in the UK Biobank. Low-risk lifestyle factors were defined as standard body mass index (BMI), drinking alcohol in moderation, nonsmoking, engaging in moderate- to vigorous-intensity physical activity, eating a high-quality diet, and maintaining a healthy sleep pattern.

Results: There were 12,403 incident T2DM cases during an average of 8.63 years of follow-up. Compared to those with 0 low-risk lifestyle factors, HRs for those with 5-6 were 0.14 (95% CI 0.10 to 0.19) for hypertensive participants, 0.13 (95% CI 0.08 to 0.19) for normotensive participants, respectively (p_trend < 0.001). 76.93% of hypertensive participants were considerably less likely to develop T2DM if they adhered to five healthy lifestyle practices, increased to 81.14% if they followed 6-factors (with a healthy sleep pattern). Compared with hypertension adults, normotensive people gain more benefits if they stick to six healthy lifestyles [Population attributable risk (PAR%) 83.66%, 95% CI 79.45 to 87.00%, p for interaction = 0.0011].

Conclusions: Adherence to a healthy lifestyle pattern including a healthy sleep pattern is associated with lower risk of T2DM in hypertensives, and this benefit is even further in normotensives.

Keywords: Hypertension; Lifestyle pattern; Type 2 diabetes mellitus; UK biobank.

Fig. 1

Effect of lifestyle factors on the risk of incident T2DM among overall and hypertension population in the UKB cohort. HRs for each group were compared with those with no healthy lifestyle factors; error bars show 95% CIs. Low-risk lifestyle factors: BMI of ≤ 24.9 kg/m²; moderate alcohol consumption (0 to 15 g/day for women and 0 to 28 g/day for men). Nonsmoking; moderate to vigorous physical activity ($150 min/week), high-quality diet (top two-fifths of healthy diet score), and healthy sleep pattern (top two-fifths of healthy sleep score). Low-risk sleep factors: early chronotype; sleep 7–8 h per day; reported never or rarely insomnia symptoms; no self-reported snoring; and no frequent daytime sleepiness. Both models were adjusted for age, sex, education, socioeconomic status, parental history of T2DM or hypertension. T2DM Type 2 Diabetes Mellitus, HR hazard ratio; CI confidence interval. All p for trend < 0.0001, calculated using the log-rank test

Fig. 2

Multivariable-adjusted population-attributable risk percents (95% CI) for incident T2DM by combining low-risk lifestyle factors among 430,971 participants. The multivariable model was adjusted for age, sex, education, socioeconomic status quintile, family history of T2DM and hypertension. All six lifestyle factors were included simultaneously in the same model. The specific combination of low-risk lifestyle factors are as follows: three lifestyle factors indicating body mass index (BMI), healthy sleep pattern, smoking. The model was also adjusted for physical activity, healthy diet, and alcohol consumption; 4 factors included the first 3 factors and physical activity. The model was additionally adjusted for healthy diet and alcohol consumption; 5 factors including the first 4 factors and alcohol consumption. The model was additionally adjusted for healthy diet; 6 factors including the first 5 factors and healthy diet