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Healthy behavior change and cardiovascular outcomes in newly diagnosed type 2 diabetic patients: a cohort analysis of the ADDITION-Cambridge study.

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Long, Gráinne H 
Cooper, Andrew JM 
Wareham, Nicholas J 
Griffin, Simon J 
Simmons, Rebecca K 


OBJECTIVE: To examine whether improvements in health behaviors are associated with reduced risk of cardiovascular disease (CVD) in individuals with newly diagnosed type 2 diabetes. RESEARCH DESIGN AND METHODS: Population-based prospective cohort study of 867 newly diagnosed diabetic patients aged between 40 and 69 years from the treatment phase of the ADDITION-Cambridge study. Because the results for all analyses were similar by trial arm, data were pooled, and results were presented for the whole cohort. Participants were identified via population-based stepwise screening between 2002 and 2006, and underwent assessment of physical activity (European Prospective Investigation into Cancer-Norfolk Physical Activity Questionnaire), diet (plasma vitamin C and self-report), and alcohol consumption (self-report) at baseline and 1 year. A composite primary CVD outcome was examined, comprised of cardiovascular mortality, nonfatal myocardial infarction, nonfatal stroke, and revascularization. RESULTS: After a median (interquartile range) follow-up period of 5.0 years (1.3 years), 6% of the cohort experienced a CVD event (12.2 per 1,000 person-years; 95% CI 9.3-15.9). CVD risk was inversely related to the number of positive health behaviors changed in the year after diabetes diagnosis. The relative risk for primary CVD event in individuals who did not change any health behavior compared with those who adopted three/four healthy behaviors was 4.17 (95% CI 1.02-17.09), adjusting for age, sex, study group, social class, occupation, and prescription of cardioprotective medication (P for trend = 0.005). CONCLUSIONS: CVD risk was inversely associated with the number of healthy behavior changes adopted in the year after the diagnosis of diabetes. Interventions that promote early achievement of these goals in patients with newly diagnosed diabetes could help reduce the burden of diabetes-related morbidity and mortality.



Adult, Aged, Cardiovascular Diseases, Case-Control Studies, Diabetes Mellitus, Type 2, Female, Health Behavior, Humans, Male, Middle Aged, Myocardial Infarction, Outcome and Process Assessment, Health Care, Prospective Studies, Risk, Risk Reduction Behavior, Stroke

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Diabetes Care

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American Diabetes Association
Medical Research Council (MC_UU_12015/1)
Medical Research Council (MC_UU_12015/4)
Medical Research Council (G0001164)
NIHR Central Commissioning Facility (NIHRDH-RP-PG-0606-1259)
Wellcome Trust (061895/Z/00/Z)
Medical Research Council (MC_U106179471)
Medical Research Council (MC_U106179474)
ADDITION-Cambridge was supported by the Wellcome Trust (grant reference no: G061895); the Medical Research Council (grant reference no: G0001164); the National Institute for Health Research (NIHR) Health Technology Assessment Programme (grant reference no: 08/116/300); National Health Service R&D support funding (including the Primary Care Research and Diabetes Research Networks); and the National Institute for Health Research. SJG receives support from the Department of Health NIHR Programme Grant funding scheme [RP-PG-0606-1259]