Neighborhood environments may influence incidence of diabetes [MESA study]

1. Greater access to healthy food and physical activity resources were associated with lower risk of incident type 2 diabetes mellitus (T2DM).

2. Social environmental factors such as safety and social cohesion were not associated with T2DM incidence.

Evidence Rating Level: 2 (Good)

Study Rundown: Behaviour modification is an important means of managing T2DM. However, it is unclear how one’s physical and social environments impact the success of changing patient’s habits. This study aimed to determine whether long-term exposures to physical and social neighbourhood environments were associated with incident T2DM.

A lower risk of developing T2DM was associated with long-term exposure to residential environments with resources supporting physical activity as well as healthy diets. However, neighborhood social factors, such as safety and social cohesion, were not associated with T2DM incidence. Strengths of this study included use of multiple survey and geographic analytic means to measure neighbourhood environmental factors. However, there remained differences in the associations found by exposure method, and therefore a greater understanding of the validity of such methods would be beneficial.

Click to read the study, published today in JAMA Internal Medicine

Click to read an invited commentary in JAMA Internal Medicine

Relevant Reading: Globalization of diabetes: the role of diet, lifestyle and genes

In-Depth [retrospective cohort]: This large cohort study used data from the Multi-Ethnic Study of Atherosclerosis (MESA), which selected participants who did not have clinical cardiovascular disease from July 2000 to August 2002, and followed them for outcomes during 4 subsequent examinations through to February 2012. Incident T2DM was determined at each examination according to plasma glucose levels or use of oral antihyperglycemics or insulin. Physical (neighborhood healthy food and physical activity resources) and social environmental factors (safety and social cohesion) were determined through geographic information system analysis or survey-based scales.

Over 9 years of follow-up, 12% of participants developed T2DM. Comparison of sociodemographic characteristics showed that those with greater risk factors for T2DM were more likely to live in neighbourhoods with fewer resources. Lower incidence of T2DM was associated with access to neighbourhood healthy food (HR per interquartile range [IQR] increase in summary score 0.88, 95%CI 0.79-0.98) and physical activity resources (HR per IQR increase 0.79, 95%CI 0.71-0.88). Social environmental factors (safety and social cohesion) were not associated with risk for T2DM (HR per IQR increase 0.96, 95%CI 0.86-1.07).

Image: PD

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