Do adolescent sedentary behavior levels predict type 2 diabetes risk in adulthood?

Scandiffio, J. A., & Janssen, I. et al | 2021| Do adolescent sedentary behavior levels predict type 2 diabetes risk in adulthood? | BMC Public Health | 21| 969 

This longitudinal study builds on the work of a previous study which looked at sedentary behaviour in adolescence to determine whether this predicts type 2 diabetes. The purpose of this study was to determine whether different levels of both screen-based and non-screen based sedentary behaviours during adolescence are associated with the risk of developing type 2 diabetes in adulthood. They studied these associations using data from the 970 British Cohort Study with assessments of sedentary behaviour at age 16 and a subsequent 30-year follow-up for incident cases of type 2 diabetes.

The research team observed that 16-year-olds who watched TV and videos for more than 4 h/day had a twofold increased risk for developing type 2 diabetes over the next three decades

Time spent using a computer, doing homework, and reading at age 16 were not associated with type 2 diabetes risk.


The objective was to determine whether time spent in different types of sedentary behavior during adolescence are associated with the risk of developing type 2 diabetes in adulthood.


Participants were 3 942 adolescents aged 16 years who were part of the 1970 British Cohort Study. Sedentary behavior was assessed using a questionnaire that asked participants to indicate how much time they spent watching TV and videos, using the computer, reading, and doing homework. Incident cases of type 2 diabetes were determined quadrennially until 46 years of age. The association between adolescent sedentary behaviors and type 2 diabetes was determined using Cox proportional hazards regression that controlled for sex, body mass index, sugary beverage consumption, smoking status, physical activity at baseline, and physical activity in adulthood .


There were 91 incident cases of type 2 diabetes with an incidence rate of 9 cases/10,000 person-years. By comparison to those who watched TV and videos for 2 or less hours/day, type 2 diabetes risk was not different in those who watched for 2.1–4.0 h/day (HR equal to 0.89, 95 per cent CI  equal to  0.54, 1.47) but was increased by 2.06-fold (95 per cent CI  equal to  1.24, 3.43) in those who watched for more than 4 h/day. Time spent using a computer, reading, and doing homework were not significantly associated with type 2 diabetes.


Spending more than 4 h/day watching television and videos at age 16 was associated with an increased risk of type 2 diabetes. Conversely, using a computer and non-screen based sedentary behaviors were not associated with type 2 diabetes risk.

Primary paper Do adolescent sedentary behavior levels predict type 2 diabetes risk in adulthood?

Regular use of proton pump inhibitors and risk of type 2 diabetes: results from three prospective cohort studies

Yuan, J. et al. (2020). Regular use of proton pump inhibitors and risk of type 2 diabetes: results from three prospective cohort studies | BMJ Gut|

New evidence indicates that taking acid reflux drugs on a regular basis may increase an individual’s risk of developing type 2 diabetes. BMJ Gut has published research that analysed data from over 200 000 participants who did not have diabetes at the study’s outset, researchers observed the risk of developing diabetes following regular ingestion of proton pump inhibitors (PPSIs) rose by a quarter, an even more marked risk was noted in individuals who used the reflux drugs over longer periods of time.

Significance of this study
What is already known about this subject?
  • Despite the irreplaceable role of proton pump inhibitors (PPIs) in clinical practice, long-term use of PPIs has been linked to a series of health problems such as bone fracture and enteric infections.
  • PPIs have a major impact on gut microbiome which, in turn, may increase the risk of type 2 diabetes, but epidemiological evidence remains unclear.
What are the new findings?
  • In this prospective analysis of 204 689 participants free of diabetes from three ongoing US cohorts, regular use of PPIs was associated with a 24% increased risk of diabetes even after adjusting for putative risk factors and indications for use, with a higher risk observed in individuals with a longer duration of PPI use.
How might it impact on clinical practice in the foreseeable future?
  • Physicians should be aware of the potential risk of type 2 diabetes when prescribing PPIs, particularly for long-term treatment.
  • Screening for abnormal blood glucose and type 2 diabetes may be required for regular PPI users, particularly for high-risk populations.


Objective The association between the regular use of proton pump inhibitors (PPIs) and the risk of type 2 diabetes remains unclear, although a recent randomised controlled trial showed a trend towards increased risk. This study was undertaken to evaluate the regular use of PPIs and risk of type 2 diabetes.

Method This is a prospective analysis of 204 689 participants free of diabetes in the Nurses’ Health Study (NHS), NHS II and Health Professionals Follow-up Study (HPFS). Type 2 diabetes was confirmed using American Diabetes Association (ADA) diagnostic criteria. We evaluated hazard ratios (HRs) adjusting for demographic factors, lifestyle habits, the presence of comorbidities, use of other medications and clinical indications.

Results We documented 10 105 incident cases of diabetes over 2 127 471 person-years of follow-up. Regular PPI users had a 24% higher risk of diabetes than non-users. The risk of diabetes increased with duration of PPI use. Fully adjusted HRs were 1.05 for participants who used PPIs for >0–2 years and 1.26 for participants who used PPIs for >2 years compared with non-users.

Conclusions Regular use of PPIs was associated with a higher risk of type 2 diabetes and the risk increased with longer duration of use. Physicians should therefore exercise caution when prescribing PPIs, particularly for long-term use.

Regular use of proton pump inhibitors and risk of type 2 diabetes: results from three prospective cohort studies

The effect of health lifestyle habits on life expectancy and type 2 diabetes

Li, Y. | 2020  |Healthy lifestyle and life expectancy free of cancer, cardiovascular disease, and type 2 diabetes: prospective cohort study | BMJ |368|  doi:

A new cohort study uses data from the Nurses’ Health Study (NHS) and 28 years of follow-up in the Health Professions Follow-up Study (HPFS) to look at the impact of habits on lifestyle, the team behind the research examine the effect of healthy lifestyle factors on life expectancy free of cancer, cardiovascular disease, and type 2 diabetes. Participants of both studies completed questionnaires about their diet, exercise, smoking status, and other factors (questions on the use of postmenopausal hormone replacement therapies and reproduction related questions were asked in the NHS only). Data on their age, ethnicity, and family history (either presence or absence) was also collected about diabetes, cancer, or myocardial infarction (in first degree relatives)- this was collected via biennial questionnaires. 

Their observations suggest that a healthier lifestyle was associated with a lower risk of cancer, cardiovascular disease, and diabetes as well as mortality, with an increased total life expectancy and number of years lived free of these diseases (Source: Li et al, 2020).



Objective To examine how a healthy lifestyle is related to life expectancy that is free from major chronic diseases.

Design Prospective cohort study.

Setting and participants The Nurses’ Health Study (1980-2014; n=73 196) and the Health Professionals Follow-Up Study (1986-2014; n=38 366).

Main exposures Five low risk lifestyle factors: never smoking, body mass index 18.5-24.9, moderate to vigorous physical activity (less than or equal to 30 minutes/day), moderate alcohol intake (women: 5-15 g/day; men 5-30 g/day), and a higher diet quality score (upper 40%).

Main outcome Life expectancy free of diabetes, cardiovascular diseases, and cancer.

Results The life expectancy free of diabetes, cardiovascular diseases, and cancer at age 50 was 23.7 years (95% confidence interval 22.6 to 24.7) for women who adopted no low risk lifestyle factors, in contrast to 34.4 years (33.1 to 35.5) for women who adopted four or five low risk factors. At age 50, the life expectancy free of any of these chronic diseases was 23.5 (22.3 to 24.7) years among men who adopted no low risk lifestyle factors and 31.1 (29.5 to 32.5) years in men who adopted four or five low risk lifestyle factors. For current male smokers who smoked heavily (more than or equal to 15 cigarettes/day) or obese men and women (body mass index more than or equal to 30), their disease-free life expectancies accounted for the lowest proportion (less than or equal to 75%) of total life expectancy at age 50.

Conclusion Adherence to a healthy lifestyle at mid-life is associated with a longer life expectancy free of major chronic diseases.

Read the full article at the  BMJ

In the news:

BBC News Healthy habits ‘deliver extra disease-free decade’ 


Obesity and poor lifestyle increase type 2 diabetes-risk independent of genetic predisposition

Jakupovic, H. et al | 2019| Obesity and unfavourable lifestyle increase type 2 diabetes-risk independent of genetic predisposition

Research that will be presented at this week’s Annual Meeting of the European Association for the Study of Diabetes (EASD), suggests that people with poor lifestyle and obesity are at greater risk of developing type 2 diabetes (via OnMedica). 

Favourable lifestyle was defined as having at least three of the following healthy lifestyle factors: no current smoking, moderate alcohol consumption, regular physical activity, and a healthy diet; whereas an unfavourable lifestyle as no or only one healthy lifestyle factor; and the remaining participants were defined as having an intermediate lifestyle. They also assessed genetic risk score (GRS) according to 213 genetic loci robustly associated with T2D, and stratified people’s GRS as low (lowest 25%), intermediate (middle 50%), and high-risk (top 25%) groups.


The abstract for the research is available from the European Association for the Study of Diabetes 

Research retrieved from:!resources/obesity-and-unfavourable-lifestyle-increase-type-2-diabetes-risk-independent-of-genetic-predisposition-128e36e7-81ac-4126-960a-823559bb5c14

See also: OnMedica Obesity linked to nearly six-fold risk of developing type 2 diabetes


New online type II diabetes support

The NHS has announced that it will be offering online support for patients with type II diabetes to help them manage their condition, via a first of its kind service | via PharmaTimes online

A new online portal in partnership with Changing Health will offer people with type II diabetes evidence-based information and support, which will be available at the touch of a button, giving them convenient and quick help to deal with the physical and mental challenges of diabetes.


Patients have already made use of the online courses and information to help reduce their blood glucose levels, a crucial part of managing type II diabetes.

The collaboration with Changing Health will see the largest ever roll out of free digital support for people diagnosed with type II diabetes, which currently costs the NHS around £8.8 billion a year.

The company says that the partnership will allow the NHS to offer its patients highly personalised support to make positive lifestyle changes and crucially sustain them over the long term.

Full story at PharmaTimes online

Dietary carbohydrate intake and mortality

Study finds both high and low percentages of carbohydrate diets were associated with increased mortality, with minimal risk observed at 50–55% carbohydrate intake | The Lancet Public Health

Low carbohydrate diets, which restrict carbohydrate in favour of increased protein or fat intake, or both, are a popular weight-loss strategy. However, the long-term effect of carbohydrate restriction on mortality is controversial and could depend on whether dietary carbohydrate is replaced by plant-based or animal-based fat and protein. We aimed to investigate the association between carbohydrate intake and mortality.

We studied 15 428 adults aged 45–64 years, in four US communities, who completed a dietary questionnaire at enrolment in the Atherosclerosis Risk in Communities (ARIC) study (between 1987 and 1989), and who did not report extreme caloric intake. The primary outcome was all-cause mortality. We investigated the association between the percentage of energy from carbohydrate intake and all-cause mortality, accounting for possible non-linear relationships in this cohort. We further examined this association, combining ARIC data with data for carbohydrate intake reported from seven multinational prospective studies in a meta-analysis. Finally, we assessed whether the substitution of animal or plant sources of fat and protein for carbohydrate affected mortality.

During a median follow-up of 25 years there were 6283 deaths in the ARIC cohort, and there were 40 181 deaths across all cohort studies. In the ARIC cohort, after multivariable adjustment, there was a U-shaped association between the percentage of energy consumed from carbohydrate (mean 48·9%, SD 9·4) and mortality: a percentage of 50–55% energy from carbohydrate was associated with the lowest risk of mortality. In the meta-analysis of all cohorts (432 179 participants), both low carbohydrate consumption (lees than 40%) and high carbohydrate consumption (more than 70%) conferred greater mortality risk than did moderate intake, which was consistent with a U-shaped association (pooled hazard ratio 1·20, 95% CI 1·09–1·32 for low carbohydrate consumption; 1·23, 1·11–1·36 for high carbohydrate consumption). However, results varied by the source of macronutrients: mortality increased when carbohydrates were exchanged for animal-derived fat or protein (1·18, 1·08–1·29) and mortality decreased when the substitutions were plant-based (0·82, 0·78–0·87).

Both high and low percentages of carbohydrate diets were associated with increased mortality, with minimal risk observed at 50–55% carbohydrate intake. Low carbohydrate dietary patterns favouring animal-derived protein and fat sources, from sources such as lamb, beef, pork, and chicken, were associated with higher mortality, whereas those that favoured plant-derived protein and fat intake, from sources such as vegetables, nuts, peanut butter, and whole-grain breads, were associated with lower mortality, suggesting that the source of food notably modifies the association between carbohydrate intake and mortality.

Full reference: Seidelmann, S. B. et al. | Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis | The Lancet Public Health | published August 16, 2018

Following heart health guidelines may also reduce diabetes risk, finds US research

Science Daily | January 2019 | Following heart health guidelines also reduces diabetes risk

Lifestyle characteristics that are associated with supporting a healthy heart have also been found to reduce the risk of diabetes, in a new US study.  Researchers at Ohio State Wexner Medical Center, assessed diabetes among 7,758 participants in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study and used the American Heart Association’s Life’s Simple 7 as a guide for measuring heart health among the group.



The Simple 7 health factors and lifestyle behaviours characteristics are:

  • physical activity
  • diet
  • weight
  • cholesterol
  • blood pressure
  • blood glucose
  • tobacco use

Overall, the study participants who were in the recommended, ideal ranges for at least four of the seven health factors had a 70 per cent lower risk of developing diabetes over the next decade.

Lead author of the study Dr. Joshua J. Joseph, an endocrinologist and assistant professor at The Ohio State University Wexner Medical Center, said:

“What’s interesting is when we compared people who had normal blood glucose and those who already had impaired blood glucose; those in normal levels who attained four or more guideline factors had an 80 percent lower risk of developing diabetes. Those who were already diabetic or prediabetic and met four of the factors had no change in lowering their risk for diabetes.”

He added: “Healthy people need to work to stay healthy. Follow the guidelines. Don’t proceed to high blood sugar and then worry about stopping diabetes. By that point, people need high-intensity interventions that focus on physical activity and diet to promote weight loss and, possibly, medications to lower the risk of diabetes.”

Read the full news story from Science Daily

The findings are published in the latest issue of Diabetologia 


Ideal cardiovascular health (CVH) is associated with lower diabetes risk. However, it is unclear whether this association is similar across glycaemic levels (normal [<5.6 mmol/l] vs impaired fasting glucose [IFG] [5.6–6.9 mmol/l]).



A secondary data analysis was performed in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Incident diabetes was assessed among 7758 participants without diabetes at baseline (2003–2007) followed over 9.5 years. Baseline cholesterol, blood pressure, diet, smoking, physical activity and BMI were used to categorise participants based on the number (0–1, 2–3 and more than or equal to 4) of ideal CVH components. Risk ratios (RRs) were calculated using modified Poisson regression, adjusting for cardiovascular risk factors.


Among participants (mean age 63.0 [SD 8.4] years, 56% female, 73% white, 27% African-American), there were 891 incident diabetes cases. Participants with equal to or more than 4 vs 0–1 ideal CVH components with normal fasting glucose (n = 6004) had 80% lower risk, while participants with baseline IFG (n = 1754) had 13% lower risk.  Additionally, the magnitude of the association of ideal CVH components with lower diabetes risk was stronger among white than African-American participants (p for interaction = 0.0338).



A higher number of ideal CVH components was associated with a dose-dependent lower risk of diabetes for participants with normal fasting glucose but not IFG. Tailored efforts that take into account observed differences by race and glycaemic level are needed for the primordial prevention of diabetes.


Science Daily Following heart health guidelines also reduces diabetes risk

This article is available to Rotherham NHS staff  and can be requested here 

‘Drink Free Days’ to encourage middle- aged drinkers to cut down

Public Health England | September 2018 |Public Health England and Drinkaware launch Drink Free Days

A new press release from Public Health England highlights how two thirds of regular drinkers say that cutting down on their drinking is harder than improving diet or exercise.

In a new collaboration Public Health England and alcohol education charity Drinkaware have  jointly launching a new campaign ‘Drink Free Days’ to help people cut down on the amount of alcohol they are regularly drinking. 


The campaign has been designed to encourage middle aged drinkers to reduce their alcohol intake by taking days off from drinking, which is a way of reducing health risks from alcohol.

The more alcohol people drink , the greater their risk of developing a number of serious potentially life limiting health conditions, such as high blood pressure and heart disease, as well as 7 types of cancer (Source: PHE).


Read the full release here 

You can download the Drink Free Days app from Public Health England here 


Diabetes UK Curb your alcohol consumption and be healthier, says Public Health England

RCGP’s response to the  Alcohol guidelines ‘set for a reason’, says RCGP

Drinkaware’s Drink Compare Calculator 

In the media:

BBC News Middle-aged should have ‘drink-free’ days, say campaigners 

Preventing Type 2 diabetes

Guidance on how to optimise the NHS Diabetes Prevention Programme in order to identify those at risk of Type 2 diabetes and help lower their risk of developing the disease | Public Health England

Image source:

Healthier You: NHS Diabetes Prevention Programme (NHS DPP)

The NHS DPP is a joint commitment from Public Health England, NHS England and Diabetes UK. The Programme, launched in 2015, delivers evidence based behavioural interventions at scale for individuals identified as being at high risk of developing Type 2 diabetes.

The NHS DPP is underpinned by a strong evidence base. PHE has published a systematic review and meta-analysis examining the effectiveness of diabetes prevention programmes.

The goals of the NHS DPP are to:

  • reduce the incidence of Type 2 diabetes
  • reduce the incidence of complications associated with Type 2 diabetes – heart, stroke, kidney, eye and foot problems related to diabetes
  • reduce health inequalities associated with incidence of Type 2 diabetes, over the longer term

In the short-term, the Programme recognises that a stronger focus on identifying people who are at risk of diabetes is likely to increase recorded incidence of diabetes as more undiagnosed cases are uncovered. This is important to recognise as it is possible to live for some time with undiagnosed Type 2 diabetes; in 2015, an estimated 900,000 people had Type 2 diabetes but were undiagnosed.

There is strong international evidence that demonstrates how behavioural interventions, with a focus on supporting people to maintain a healthy weight and be more active, can significantly reduce the risk of developing Type 2 diabetes. The NHS DPP behavioural intervention reflects this evidence, as it is underpinned by 3 core goals:

  • achieving a healthy weight
  • achievement of dietary recommendations
  • achievement of the Chief Medical Officers’ (CMO) physical activity recommendations
Dr Jonathan Valabhji outlines the aims of NHS Diabetes Prevention Programme

Full detail: Health matters: preventing Type 2 Diabetes