Considering the overall quality of management of diabetes, the efficacy of lifestyle management is lagging behind considerably relative to pharmacological treatment as the large majority of patient fails to achieve any lifestyle treatment aim, despite substantial efforts and costs for lifestyle management. Hence, there is a large unmet need for better lifestyle management.
Recent studies on determinants of effective lifestyle management underline the importance of considering personal preferences and habits, and environmental factors as success factors for sustained efficacy. In diabetes however, little attention has been given to identifying habits and preferences, assessment of environmental factors, or assessing their associations with morbidity and their consequences for (better) management. Assessment of robust lifestyle patterns provides a relevant strategy to map habits and preferences at the aggregate level, and analyze for relevant environmental determinants that can guide better intervention strategies.
In the Lifelines cohort (n=160,000) we identified several dietary patterns, robust after adjustment for confounders. These patterns strongly associate with (multi-) morbidity, demonstrating their clinical relevance. Moreover, their marked regional distribution supports the role of (socio-cultural) environmental factors. This provides an excellent starting point to analyze the role of lifestyle patterns as determinants of morbidity in diabetes, their consequences for current management, and design of new strategies that effectively account for preferences, habits and environmental factors .
By this innovative approach of analyzing personal/environmental characteristics at the aggregate level, the project creates an intermediate level between generic approaches (one size fits all) and strictly individual approaches ( time consuming, expensive). As such it is uniquely fitted to provide an empirical basis for new approaches towards better personalization of diabetes management that are within reach with currently available technology at affordable costs.
Our underlying assumption is that better lifestyle management will facilitate overall management of diabetes, lead to lower requirements for pharmacotherapy, better outcomes and lower costs.