Link Between Healthy Behaviors and Blood Sugar Control in People with Diabetes: Findings from a National Study

A national study in the country shows that a set of healthy lifestyle behaviors is associated with better blood sugar levels in people with diabetes.

According to Ambassador Arjan, this study was conducted by the researchers of the Non-Communicable Diseases Research Center and the Endocrine and Metabolism Research Center of Tehran University of Medical Sciences and using the data of the National Survey of Risk Factors for Non-Communicable Diseases (STEPS) in 2021, and its results were published in the BMJ Open journal.

Examination of more than 3 thousand people with diabetes

The researchers analyzed data from people aged 25 and older who participated in the laboratory phase of the STEPS survey. Finally, 3042 people with diabetes were included in the analysis. Diabetes was defined as having a fasting blood sugar of at least 126 mg/dL, HbA1c of at least 6.5%, or taking blood sugar-lowering drugs.

Since the STEPS survey was conducted in all 31 provinces of Iran, this study provides a national picture of the condition of people with diabetes.

How was lifestyle measured?

The researchers created an index called the "Combined Lifestyle Index" or CLI to examine multiple behaviors simultaneously. This index considered a set of factors together:

quality and pattern of food consumption;

Based on the score of this index, people were placed in three groups with low, medium and high levels of healthy behaviors. Also, two important indicators of blood sugar, i.e. fasting blood sugar (FBS) and glycosylated hemoglobin (HbA1c) were investigated. Researchers consider HbA1c less than 7% to be a good blood sugar control.

The result was contrary to simple linear expectation

The results showed that people who were in the average group of healthy behaviors had lower fasting blood sugar and HbA1c compared to the group with the lowest level of healthy behaviors.

After considering various demographic and clinical factors, the average group had about 7.36 mg/dL of fasting blood sugar and 0.27 percentage units of HbA1c lower than the group with the lowest lifestyle score. Also, increasing the lifestyle score from the low group to the middle group was associated with 1.37 times the chance of achieving proper blood sugar control.

But the important point was that at the highest level of lifestyle score, this advantage was not greater than at the average level. Statistical analysis also showed that the relationship between lifestyle and blood sugar indicators is not linear and has a U-like pattern; That is, in these data, the highest correlation with better blood sugar status was seen at the average level of healthy behaviors, and this correlation decreased with a further increase in the score.

Awareness of diabetes has increased, but sugar control remains a challenge

The study also paid attention to the gap between awareness of diabetes and proper control of the disease.

According to the data cited by researchers, awareness of diabetes in Iran has increased from 53.5% in 2004 to 73.3% in 2021. However, increased awareness has not led to the same improvement in blood sugar control; The level of proper blood sugar control has increased from about 14.5% to 28% in the same period.

Simply put, more people are aware of their diabetes, but knowing that one has diabetes does not necessarily mean proper blood sugar control.

When a person does not know about his illness

One of the remarkable findings of the study was the difference in blood sugar patterns in people with and without diabetes.

In people who did not know about their disease, as the score of healthy lifestyle increased, the average HbA1c and fasting blood sugar also decreased. On the contrary, in people who were aware of their disease, these indicators did not show similar changes in different lifestyle groups, and even HbA1c increased slightly in the highest lifestyle group. Researchers see this difference as a sign of the complexity of the relationship between awareness, lifestyle behaviors, treatment and blood sugar control.

An important point about the interpretation of the results

The study does not show that a "very healthy lifestyle" is worse for people with diabetes than an average lifestyle. Researchers have emphasized that the findings show a non-linear statistical relationship and it cannot be concluded that increasing healthy behaviors will worsen blood sugar.

One of the possible explanations is that people with more severe diabetes may have made more efforts to change their lifestyle after diagnosis; Therefore, the observed relationship can be affected by the severity of the disease, treatment and other factors. The researchers themselves have emphasized the necessity of longitudinal studies to investigate this issue.

This research shows that the control of diabetes is not only limited to the use of drugs and a set of daily behaviors such as nutrition, physical activity and avoiding smoking should also be considered in the management of the disease.

However, the findings of this cross-sectional study should not be considered as proving a cause and effect relationship. Prospective studies are needed to determine whether lifestyle changes really improve blood sugar control and what level of intervention is most appropriate for different groups, the researchers say.