Risk factor control in relation to mortality and life expectancy among people with type 2 diabetes: results from 3 nationwide cohort studies

Zi-Xin Qiu; Frank Qian; Yan-Bo Zhang; Jun Liu; Ting-Ting Geng; Rui Li; Pang Yao; Oscar H. Franco; Eric B. Rimm; JoAnn E. Manson; An Pan; Mai-Geng Zhou; Kai Huang; Gang Liu

doi:10.1186/s40779-025-00674-4

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Risk factor control in relation to mortality and life expectancy among people with type 2 diabetes: results from 3 nationwide cohort studies

RESEARCH | Updated：2026-08-20

- Risk factor control in relation to mortality and life expectancy among people with type 2 diabetes: results from 3 nationwide cohort studies
- Risk factor control in relation to mortality and life expectancy among people with type 2 diabetes: results from 3 nationwide cohort studies
- Military Medical Research 2026年13卷第6期页码：916-928
- Affiliations：
  
  Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environment Health (Incubating),School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
  Section of Cardiovascular Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
  Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
  Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
  Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
  Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht 3584 CX, The Netherlands
  Department of Nutrition, Harvard T.H.Chan School of Public Health, Boston, MA 02115, USA
  Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
  Channing Division of Network Medicine, Department of Medicine,Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
  Department of Medicine, Brigham and Women’s Hospital,Harvard Medical School, Harvard University, Boston, MA 02115, USA
  Center for Obesity and Diabetes Research, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
  National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
  Department of Cardiovascular Diseases, Union Hospital,Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
  Clinical Center for Human Genomic Research, Union Hospital, Huazhong University of Science and Technology, Wuhan 430030, China
  Department of Cardiometabolic Diseases, Remin Hospital, Wuhan University, Wuhan 430060, China
- Author bio：
  
  * Mai-Geng Zhou zhoumaigeng@ncncd.chinacdc.cn
  Kai Huang huangkai1@hust.edu.cn
  Gang Liu liugang026@hust.edu.cn
- Funds：
  
  the National Natural Science Foundation of China(82325043);the Noncommunicable Chronic Diseases-National Science and Technology Major Project(2023ZD0508904);the National Key Research and Development Program of China(2023YFC3606300);the Fundamental Research Funds for the Central Universities(2021GCRC076)
- DOI：10.1186/s40779-025-00674-4
  中图分类号：
- 收稿：2025-06-18，
  
  录用：2025-11-15，
  
  网络首发：2025-12-05，
  
  纸质出版：2026-06
- Accepted：
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Zi-Xin Qiu, Frank Qian, Yan-Bo Zhang, 等. Risk factor control in relation to mortality and life expectancy among people with type 2 diabetes: results from 3 nationwide cohort studies[J]. Military Medical Research, 2026,13(6):916-928.

Zi-Xin Qiu, Frank Qian, Yan-Bo Zhang, et al. Risk factor control in relation to mortality and life expectancy among people with type 2 diabetes: results from 3 nationwide cohort studies[J]. Military Medical Research, 2026, 13(6): 916-928.
Zi-Xin Qiu, Frank Qian, Yan-Bo Zhang, 等. Risk factor control in relation to mortality and life expectancy among people with type 2 diabetes: results from 3 nationwide cohort studies[J]. Military Medical Research, 2026,13(6):916-928. DOI： 10.1186/s40779-025-00674-4.

Zi-Xin Qiu, Frank Qian, Yan-Bo Zhang, et al. Risk factor control in relation to mortality and life expectancy among people with type 2 diabetes: results from 3 nationwide cohort studies[J]. Military Medical Research, 2026, 13(6): 916-928. DOI： 10.1186/s40779-025-00674-4.

摘要

Abstract

Background

Type 2 diabetes (T2D) is a global epidemic that reduces life expectancy. Evidence is limited on the benefits of achieving multiple guideline-recommended targets and cross-country differences. This study aimed to quantify the associations of risk factor control with mortality and life expectancy among individuals with T2D using nationwide cohorts from China

the USA

and the UK.

Methods

We included 46

351 adults with T2D at baseline from China Chronic Disease and Risk Factors Surveillance (CCDRFS; 2013

follow-up until 2021)

USA National Health and Nutrition Examination Survey (USA NHANES;1999–2018

follow-up until 2019)

and UK Biobank (2006–2010

follow-up until 2022). Patients with T2D were matched to controls without T2D using propensity score matching based on key demographic factors. Cox regression estimated mortality associated with lifestyle and metabolic factors outside target ranges [physical inactivity

smoking

unhealthy diet

elevated hemoglobin A1c (HbA1c)

dyslipidemia

high blood pressure].

Results

Only a small proportion of participants achieved ≥ 5 combined targets: 16.0% in CCDRFS

9.9% in USA NHANES

and 6.8% in UK Biobank. During 470

369 person-years of follow-up

7650 deaths (16.5%) occurred among individuals with T2D

and 9349 deaths (10.2%) occurred among controls over 965

249 person-years. At age 50

individuals with ≤ 1 risk factor outside the target lived 6–9 years longer than those with ≥ 5

and their life expectancy was comparable to that of controls without T2D. The association was independent of genetic predisposition to shorter lifespan in the UK Biobank. Additionally

individuals with T2D who failed to achieve optimal metabolic control but maintained a healthy lifestyle had a longer life expectancy compared with those who achieved optimal metabolic control but had an unhealthy lifestyle across all cohorts

with life expectancy gains ranging from 1.5 to 3.4 years depending on sex and cohort. Among individuals with T2D

healthy lifestyle behaviors (physical activity

non-smoking

a healthy diet) and HbA1c control contributed most to gains in life expectancy. Variations in multiple risk factor control and their associations with all-cause mortality were observed across different population subgroups.

Conclusions

Achievement of guideline targets for multiple risk factors was low among individuals with T2D in China

the USA

and the UK. Comprehensive management of multiple risk factors

particularly lifestyle factors

was associated with a substantial reduction in the life expectancy gap between those with and without T2D

underscoring the importance of guideline-based care and individualized management.

关键词

Keywords

references

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