Healthy Lifestyle May Cut Infection Risk by 44% in People With Type 2 Diabetes, Study Finds

Following a Healthy Lifestyle may be linked to a substantially lower risk of infections among people living with Type 2 Diabetes mellitus (T2DM), according to a new study published in BMC Medicine. Researchers found that people with T2DM who had an ideal combination of healthy lifestyle habits experienced a 44% lower infection incidence rate than those with poor lifestyle adherence.

The study, led by Mingming Li and colleagues, analysed long-term health data from 12,885 people with type 2 diabetes enrolled in the UK Biobank. Participants were followed for a median of 13.1 years. The researchers examined lifestyle factors including smoking, body weight, diet, physical activity, sleep and alcohol consumption, and investigated how these factors were associated with subsequent infections.

Healthy Lifestyle Linked to 44% Lower Infection Incidence

The researchers classified participants according to their adherence to a combination of healthy lifestyle factors. Compared with people in the poor-adherence group, those with an ideal lifestyle had an infection incidence rate ratio of 0.56.

That corresponds to an approximately 44% lower infection incidence rate. The association was also observed for specific serious infections, including pneumonia and sepsis.

It is important to understand what this number means. The study was observational, meaning researchers examined associations in an existing population rather than randomly assigning people to different lifestyles. Therefore, the 44% figure should not be interpreted as a guarantee that an individual with diabetes can prevent 44% of infections simply by changing lifestyle habits.

Why Infection Risk Matters in Type 2 Diabetes

People with type 2 diabetes are known to have an increased susceptibility to infections. This makes infection prevention an important part of maintaining long-term health alongside blood glucose management and treatment of diabetes-related risk factors.

The researchers noted that although healthy lifestyles have previously been associated with lower infection risk in the general population, it was less clear whether the same relationship applied to people already living with T2DM.

The new study specifically addressed this question by examining infection outcomes over more than a decade of follow-up.

Study Followed Nearly 13,000 People With Diabetes

The prospective cohort included 12,885 UK Biobank participants with type 2 diabetes. Their mean age was 60.1 years, and 30.6% were women.

Participants were followed for a median of 13.1 years. The researchers examined total incident infections as the primary outcome, while pneumonia, gastroenteritis and sepsis were considered secondary outcomes. Infection events were identified using hospitalisation and mortality registry information.

The study also assessed the American Heart Association’s Life’s Essential 8 (LE8) score in a subgroup of 9,164 participants. LE8 incorporates multiple dimensions of cardiovascular health and healthy living.

Which Healthy Habits Were Associated With Lower Infection Risk?

The lifestyle assessment covered several modifiable behaviours and health characteristics. Among the factors associated with lower infection incidence were:

• Never smoking
• Maintaining a healthier BMI
• Getting adequate sleep
• Regular physical activity
• Healthier dietary habits
• Healthier alcohol-consumption patterns

The results suggest that the overall combination of behaviours may matter. Rather than focusing on one isolated habit, the study examined a multidimensional lifestyle pattern.

For example, never smoking was associated with a lower infection incidence, as were adequate sleep and regular physical activity. A healthy BMI was also among the factors associated with lower infection incidence.

Life’s Essential 8 Score Showed a Dose-Dependent Association

The researchers also found an association between higher Life’s Essential 8 scores and lower infection incidence.

Every 5-point increase in the LE8 score was associated with an 11% lower infection incidence rate. The incidence rate ratio was 0.89, with a 95% confidence interval of 0.87 to 0.91.

The dose-dependent pattern is noteworthy because it suggests that incremental improvements across multiple areas of health may be associated with lower infection incidence. It does not mean, however, that increasing an individual’s LE8 score by five points will necessarily produce an 11% reduction in their personal infection risk.

Study Also Explored the Biology Behind the Association

The researchers went beyond lifestyle and infection statistics by investigating potential biological pathways that could help explain the observed associations.

They conducted multi-omics mediation analyses using both metabolomics and proteomics data. The metabolomics analysis included 8,971 participants and examined 325 metabolic biomarkers, while the proteomics analysis included 1,078 participants and examined 2,920 proteins.

The findings pointed toward lipid and fatty acid metabolism as potentially important pathways. Measures involving fatty acid unsaturation, HDL-related lipids and GlycA were among the metabolic factors highlighted in the analysis.

The protein analysis also identified potential links involving inflammatory and innate immune pathways. TRAIL-R2 and Galectin-9 were among the proteins identified as potential mediators.

What Could Lipid Metabolism and Inflammation Have to Do With Infection?

The biological findings provide possible clues about why lifestyle and infection incidence could be connected in people with T2DM.

Metabolism and immune function are closely interconnected. Factors such as body composition, physical activity, diet and smoking can influence metabolic and inflammatory processes. In people with diabetes, these pathways may be particularly relevant because metabolic disturbances can coexist with changes in immune function.

However, the mediation analysis should be interpreted cautiously. Identifying biomarkers statistically associated with the relationship does not prove that changing one particular lipid, protein or inflammatory pathway will prevent infections.

Pneumonia and Sepsis Also Showed Associations

The association was not limited to infections considered as a single broad category. The researchers reported similar reductions for pneumonia and sepsis among participants with healthier lifestyle profiles.

This is clinically relevant because severe infections can result in hospitalisation and can be particularly consequential for people who already have chronic metabolic disease.

Still, the study does not establish that healthy living directly prevents pneumonia or sepsis. The results describe patterns observed across a large population during long-term follow-up.

What the Findings Mean for People With Type 2 Diabetes

The results reinforce the broader importance of lifestyle management as part of comprehensive diabetes care.

Regular physical activity, avoiding tobacco, maintaining a healthy body weight, eating a balanced diet and getting adequate sleep are already recognised components of a healthy lifestyle. The new findings suggest that these behaviours may also be associated with a lower burden of infections among people with T2DM.

For someone living with diabetes, this does not mean lifestyle changes should replace prescribed treatment. Instead, lifestyle management can form one part of a wider prevention strategy that includes appropriate medical care, blood glucose management, recommended vaccinations and timely evaluation of possible infections.

Why the 44% Finding Should Be Interpreted Carefully

The size of the association is striking, but the study has important limitations.

First, it was a prospective observational cohort study, not a randomised clinical trial. Researchers can adjust for many potential confounding factors, but observational studies cannot completely rule out the possibility that other differences between participants contributed to the results.

Second, lifestyle behaviours can change over time. A single assessment may not completely represent a person’s long-term smoking, diet, physical activity, sleep or alcohol habits.

Third, the participants came from the UK Biobank, so the findings may not automatically apply to every population or healthcare setting. Differences in ethnicity, healthcare access, socioeconomic conditions, diabetes management and infection patterns could affect how the findings translate to other groups.

For these reasons, the 44% figure should be viewed as a population-level association rather than an individual prediction.

Healthy Lifestyle and Diabetes: The Bigger Picture

The study adds another dimension to the established importance of lifestyle management in type 2 diabetes.

Diabetes care often focuses heavily on blood glucose, but long-term health is influenced by multiple interconnected factors. Physical activity, nutrition, sleep, smoking status and weight can affect metabolic health, cardiovascular risk and overall wellbeing.

The new research suggests that infection incidence may also be linked to this broader health profile. Its multi-omics findings provide potential biological explanations involving lipid metabolism and immune-inflammatory pathways, although further research is needed to determine whether these mechanisms are causal.

Key Findings From the Study

• The study included 12,885 people with type 2 diabetes from the UK Biobank.
• Participants were followed for a median of 13.1 years.
• Ideal lifestyle adherence was associated with an approximately 44% lower infection incidence rate compared with poor adherence.
• Never smoking, healthy BMI, adequate sleep and physical activity were among the important lifestyle factors associated with lower infection incidence.
• Every 5-point increase in the Life’s Essential 8 score was associated with an 11% lower infection incidence rate.
• The researchers identified potential links involving lipid and fatty acid metabolism and immune-inflammatory pathways.
• The study was observational, so it demonstrates an association rather than proving that lifestyle changes directly prevent infections.

Bottom Line

A healthy lifestyle was associated with a substantially lower incidence of infections among people with type 2 diabetes in a large, long-term UK Biobank study. Participants with ideal lifestyle adherence had an approximately 44% lower infection incidence rate than those with poor adherence, while higher Life’s Essential 8 scores were also associated with lower infection incidence.

The findings highlight the potential importance of everyday factors such as physical activity, smoking avoidance, healthy weight, adequate sleep and diet in people with T2DM. However, the study does not prove that lifestyle changes alone prevent infections, and the 44% figure should not be treated as an individual guarantee. The research instead adds evidence that comprehensive lifestyle management may be an important component of reducing health risks associated with type 2 diabetes.