The statistics are concerning: Diabetes affects about 26 million U.S. adults—almost 11 million of whom are 65 or older. Without dramatic lifestyle changes, more than one-third of Americans will have diabetes by 2050, predicts the Centers for Disease Control and Prevention (CDC).

By making five healthy lifestyle changes associated with weight, nutrition, activity, smoking and alcohol, you can dramatically lower your diabetes risk, suggests new research. Each factor alone reduces diabetes risk by more than 30 percent. Together, they're associated with lowering risk by 72 percent for men and 80 percent for women.

About the study

The analysis, by the National Institutes of Health (NIH), marks the first time a combination of five specific lifestyle factors and their effects on type 2 diabetes has been put to the test so comprehensively. In the past, researchers focused mainly on the impact of individual factors. Research on combined factors has been limited.

For this latest analysis, investigators gathered data from the NIH-AARP Diet and Health Study, an unrelated study that tracked the lifestyle habits of more than 200,000 healthy men and women in the United States. At the beginning of this study, participants ranging in age from 50 to 71 completed a survey about their lifestyle habits. The new study measured the number of diabetes cases that had developed among participants 11 years later.

The new study had some limitations, most notably that the study participants didn't truly represent the U.S. population. When the study began, most participants were healthier and weighed less than the typical American in the same age range. What's more, the study subjects were mostly Caucasian, so the data may not be relevant for African Americans and Hispanics.

Another limitation was that the study wasn't clinically controlled. Since doctors didn't closely oversee participants, the findings depend on the accuracy of participants' self-reported survey responses.

The researchers also couldn't confirm that participants continued the same habits over the following decade. This means that a true cause-and-effect relationship between lifestyle and health outcome can't be proved.

Nevertheless, the results strongly imply a link between a healthy lifestyle and a lowered diabetes risk with a cumulative effect: The more healthy habits, the better your chances of not developing diabetes. And that's not all. The researchers found that even if you have a family history of diabetes - a strong risk factor - you can still reduce your risk just as much as people without a family history if you make positive changes.

Getting on the prevention track

Based on the study's outcome, it's safe to say that by making the following lifestyle changes, you can significantly avoid the onset of diabetes:

1. Keep your weight within a healthy range. Excessive weight has the single biggest impact on diabetes risk. If you're overweight or obese, losing weight is the most important lifestyle change you can make to avoid the disease. Nearly nine in 10 people newly diagnosed with diabetes are overweight or obese. If you're overweight, losing just 7 percent of your body weight (that's 14 pounds for a 200-pound person) can reduce your risk.

The new study found that the people who had a body mass index (BMI) of less than 25 were much less likely to develop type 2 diabetes. BMI indicates how much body fat you have, based on your height and weight. People whose BMI was less than 25 were 70 to 78 percent less likely to develop diabetes than people in the overweight and obese ranges. Your doctor can calculate your BMI, or you can compute it yourself at

And here's good news for people who can't lose the extra pounds: You can still reduce your risk considerably when you make other lifestyle changes.

2. Eat smart. A well-balanced diet contributes to a lower diabetes risk. Especially watch your calorie intake and practice portion control. The people in the study who were less likely to develop diabetes ate lots of fiber and cut back on foods high in unhealthy fats and sugar. To gain the same benefits, your diet should be low in fat and high in whole grains.

Get plenty of:

  • Whole-grain foods high in fiber, such as whole-grain cereal, whole-wheat bread, brown rice and oatmeal
  • Colorful fruits and vegetables like broccoli, spinach, sweet potatoes, carrots, tomatoes, watermelon and berries
  • Lean protein found in fish, poultry, lean cuts of pork or beef, beans, lentils, peas, nuts and seeds


  • Foods high in salt
  • Soda and other sugary drinks
  • Saturated and trans fats, found in fried foods, salad dressings, stick margarine, whole milk and pastries

3. Get moving. The people in the study who were considered at low risk for diabetes got at least 20 minutes of activity that increased their breathing or heart rate three times a week. The American Diabetes Association (ADA) recommends you aim for 30 minutes of moderate-intensity activity, such as brisk walking, jogging, swimming or dancing, five days a week

. The ADA suggests three other types of activity to help reduce risk:

  • Regular daily activity, like doing household chores, parking farther away from stores and simply moving around
  • Strength training, such as lifting weights
  • Flexibility training, such as stretching or yoga

4. Don't smoke. Cigarette smoking can raise blood sugar levels and has been shown to increase resistance to insulin, thereby raising your chances of developing diabetes. Smoking also affects how your pancreas processes insulin, causes inflammation throughout your body and promotes abdominal obesity (even though smokers typically weigh less than nonsmokers, they have more belly fat), all of which contribute to diabetes risk.

5. Drink alcohol in moderation. Light to moderate alcohol intake has been associated with having positive effects on insulin sensitivity in this and other studies. Alcohol may also have anti-inflammatory effects, which could help prevent diabetes. Men should have no more than two drinks a day and women no more than one drink.

However, if you don't drink, don't start. Focus on improving your other lifestyle habits instead.

Source: Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50

Publication Review By: the Editorial Staff at

Published: 21 Jul 2013

Last Modified: 10 Mar 2015