You may be able to lower your risk of type 2 diabetes simply by living in a neighbourhood that encourages exercise and gives easy access to healthy food. People living in "healthy neighbourhoods", with safe pavements, plenty of parks, easy access to fresh fruit and vegetables and good public transport, were 38% less likely to develop type 2 diabetes than people living in less healthy areas.
Dr Amy Auchincloss of Drexel University in Philadelphia and colleagues studied 2,285 people aged 45 to 84 living in Forsyth County, North Carolina; Baltimore, Maryland; and the Bronx in New York City. Neighbourhoods were rated by asking residents whether walking in their area was easy and pleasant, whether a wide range of good-quality fruit, vegetables and low-fat foods was available locally, and whether it was common to see other people exercising.
The neighbourhoods scored 3.68 on average for physical activity and 3.36 for healthy food. The research showed that people in healthier neighbourhoods were much less likely to develop type 2 diabetes over five years of follow-up, after allowing for age, income, ethnicity and education. During those five years, 10% of the participants were diagnosed with type 2 diabetes.
Participants had basic health checks between 2000 and 2002, with further checks about every 18 months, including fasting blood glucose. Other data collected included social and demographic information and the participants' descriptions of their diet and exercise routines.
"The association was substantial," the authors wrote: the lower rate of type 2 diabetes was equivalent to that linked with a 5-point difference in body mass index in this sample. With obesity and type 2 diabetes rising sharply, they noted that changing our environments, so that healthier behaviours and lifestyles become easy choices, is one of the main steps to halting or reversing these epidemics. The full report is in the Archives of Internal Medicine.
The researchers acknowledged that more research is needed to pin down the true effect of a healthy neighbourhood. The next step, Auchincloss said, is to look at how physical activity changes as neighbourhoods change over time; other Drexel researchers have already started this analysis and will also study changes in diet.
Several initiatives are under way in Philadelphia and other cities to improve neighbourhoods, she said, including farmers' markets and large supermarkets in low-income areas, cycle lanes and other low-cost projects to encourage exercise. "Current efforts to promote healthy environments include designing and modifying physical environments, such as zoning for safe pavements, creating parks and attractive green public spaces, improving public transport so residents depend less on their cars, subsidising food from farmers' markets, and helping local shops offer healthier food," the researchers wrote.
Type 2 diabetes has risen steadily over the past three decades. About 23.6 million people in the US and 246 million worldwide have diabetes, most of them type 2.
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