Genetic risk of type 2 diabetes modifies the association between lifestyle and glycemic health at 5 years postpartum among high-risk women.

Emilia Huvinen, Elina Engberg, Saila Koivusalo, Jari Lahti, Hannele Laivuori, Sim Tieu

Journal: BMJ open diabetes research & care 2024;12(2):

PMID: 38631819

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Plain Language Summary

Women who develop high blood sugar levels after pregnancy are at increased risk of type 2 diabetes later in life. Lifestyle factors such as diet and physical activity play an important role in managing blood sugar levels, but individuals may respond differently depending on their genetic risk. This follow-up of a randomised control trial was conducted to examine whether genetic risk for type 2 diabetes influences how effective lifestyle factors are in maintaining healthy blood sugar levels five years after pregnancy.

The results showed that genetic risk influenced how lifestyle factors were associated with blood sugar levels. Women with a higher genetic risk for type 2 diabetes appeared to benefit more from healthy lifestyle behaviours, showing better glycaemic outcomes when following healthier diets and maintaining physical activity.

In conclusion, genetic risk for type 2 diabetes may modify the long-term effects of lifestyle on blood sugar health after pregnancy. Healthcare professionals may use this information to support more personalised lifestyle recommendations, particularly for women at higher genetic risk, to help prevent the development of type 2 diabetes.

Abstract

INTRODUCTION

Lifestyle interventions are effective in preventing type 2 diabetes, but genetic background may influence the individual response. In the Finnish gestational diabetes prevention study, RADIEL, lifestyle intervention during pregnancy and first postpartum year was effective in preventing gestational diabetes (GDM) and postpartum glycemic abnormalities only among women at highest genetic risk of type 2 diabetes. This study aimed to assess whether still 5 years postpartum the genetic risk modifies the association between lifestyle and glycemic health.

RESEARCH DESIGN AND METHODS

The RADIEL study (randomized controlled trial) aimed to prevent GDM with a lifestyle intervention among high-risk women (body mass index ≥30 kg/m and/or prior GDM). The follow-up study 5 years postpartum included anthropometric measurements, laboratory assessments, device-measured physical activity (PA), and questionnaires. A Healthy Lifestyle Score (HLS) indicated adherence to lifestyle goals (PA, diet, smoking) and a polygenic risk score (PRS) based on 50 type 2 diabetes risk alleles depicted the genetic risk.

RESULTS

Altogether 314 women provided genetic and glycemic data 5 years postpartum. The PRS for type 2 diabetes was not associated with glycemic abnormalities, nor was HLS in the total study sample. There was, however, an interaction between HLS and type 2 diabetes PRS on glycemic abnormalities (p=0.03). When assessing the association between HLS and glycemic abnormalities in PRS tertiles, HLS was associated with reduced risk of glycemic abnormalities only among women at the highest genetic risk (p=0.008).

CONCLUSIONS

These results extend our previous findings from pregnancy and first postpartum year demonstrating that still at 5 years postpartum, healthy lifestyle is associated with a lower risk of prediabetes/diabetes only among women at the highest genetic risk of type 2 diabetes.

Address: Helsinki University Central Hospital, Helsinki, Finland [email protected].; University of Helsinki, Helsinki, Finland.; Department of Psychology, University of Helsinki, Helsinki, Finland.; Folkhälsan Research Center, Helsinki, Finland.; Folkhälsan Research Center, Helsinki, Finland.; Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland.; Medical and Clinical Genetics, Helsinki University Hospital, Helsinki, Finland.; Tampere University, Tampere, Finland.; Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland.

DOI: 10.1136/bmjdrc-2023-003942