Community resources affect prevalence of type 2 diabetes

Individuals who live in neighborhoods that offer greater resources to physical activity are less likely to develop type 2 diabetes, according to recently published data in JAMA Internal Medicine.

The data also suggested an association, albeit a smaller one, between healthier diets and rates of type 2 diabetes.

“Long-term exposure to residential environments with greater resources to support physical activity and, to a lesser extent, healthy diets, was associated with a lower incidence of [type 2 diabetes mellitus], although results varied by measurement method. Modifying neighborhood environments may represent a complementary, population-based approach to prevention of [type 2 diabetes mellitus],” the researchers wrote.

Researchers evaluated data from the Multi-Ethnic Study of Atherosclerosis to assess the link between type 2 diabetes and long-term neighborhood physical and social environmental exposures. Physical activity resources included commercial recreational establishments, such as indoor conditioning facilities, centers for dance, golf, bowling, team and racquet sports, and water activities. Access to food options included geographic distance to stores more likely to sell a selection of healthy foods.

All participants (n = 5,124) were free of type 2 diabetes at baseline, and underwent five clinical evaluations during the study period, July 17, 2000 to February 4, 2012. 

Results demonstrated that 12% of participants developed type 2 diabetes during a median follow up of 8.9 years. Those who developed type 2 diabetes were more likely to be black or Hispanic, have a lower-household income, have less education, unhealthy diets, be less likely to exercise, have a higher BMI, and have family history of type 2 diabetes.

Generally, a high association between race and physical activity resources was found, with ethnic minorities being significantly more likely to live in areas that had fewer resources.

After adjusting for age, sex, income, education, race and alcohol and tobacco use, results indicated that participants living in neighborhoods with more physical activity resources were 21% (95% CI, 0.71-0.88) less likely to develop type 2 diabetes. Additionally, participants with access to healthier food choices were 12% (95% CI, 0.79-0.98) less likely to develop type 2 diabetes.

“Our results suggest that modifying specific features of neighborhood environments, including increasing the availability of health foods and [physical activity] resources, may help to mitigate the risk for [type 2 diabetes mellitus], although additional intervention studies with measures of multiple neighborhood features are needed. Such approaches may be especially important for addressing disparities in [type 2 diabetes mellitus] given the concentration of low-income and minority populations in neighborhoods with fewer health-promoting resources,” the researchers concluded.

In an accompanying editorial, Nancy E. Adler, PhD, and Aric A. Prather, PhD, of the Center for Health and Community, University of California, San Francisco, noted that to combat the rising rates of type 2 diabetes, partnerships between health care systems and public health and city planners must be made. These collaborations would take into account biological, psychosocial and demographic characteristics of neighborhood populations, to ensure incidences of type 2 diabetes are decreasing.

“In sum, the findings by Christine et al point to the impact of perceived neighborhood resources. Having markets and recreational facilities located nearby may be necessary but not sufficient to enable health behaviors. In brief, the risk for [type 2 diabetes mellitus] is a combination of both person and place, and our national strategies need to understand and intervene across these levels,” Adler and Prather wrote. – by Casey Hower

Disclosure: The researchers report no relevant financial disclosures.

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