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The study found that the risk of developing diabetes was 12 percent lower in neighborhoods with access to healthy foods. The researchers also found a 21 percent reduced risk of type 2 diabetes in areas with greater opportunities for physical activity.
"Most of the efforts to prevent type 2 diabetes focus on individuals," said lead researcher Paul Christine of the University of Michigan School of Public Health in Ann Arbor, Mich. "Our study points to the need to consider neighborhood environments as targets that could complement individual-based intervention programs," he said.
A greater availability of places to exercise included gyms and pleasant places to walk, Christine said.
And, while the availability of healthy food was important, "simply having more supermarkets or fruit and vegetable markets in one's neighborhood did not translate into a lower risk for diabetes," Christine said.
Other factors that played a role included the cost of healthy food and the ability of residents to afford it, he said.
The report was published in the June 29 online edition of JAMA Internal Medicine.
For the study, Christine's team collected data on more than 5,000 people who didn't have type 2 diabetes at the start of the study. The participants' health was followed from 2000 to 2012.
The researchers collected data on the neighborhoods the participants lived in, particularly on the availability of healthy food and safe places to exercise.
During the study period, 12 percent of the participants developed type 2 diabetes, the investigators found.
Type 2 diabetes was more likely to be diagnosed in people who were black or Hispanic, or who had low incomes or less education, the study found. People who developed type 2 diabetes were also more likely to be overweight or obese and have a family history of type 2 diabetes. Those who ended up with diabetes were also less likely to exercise or to have a healthy diet, the researchers said.
Nancy Adler, a professor of medical psychology and director of the Center for Health and Community at the University of California, San Francisco, said that although dealing with the medical aspects of type 2 diabetes is important, social and behavioral conditions play a much greater role in determining who will become ill.
"People's ability to engage in behaviors that will reduce their risk of diabetes is limited by their personal resources, like income, as well as by the resources available in their neighborhoods," said Adler, who's also the co-author of an accompanying editorial in the journal.
Even in neighborhoods where resources are available, people have to have the ability to take advantage of them, Adler said.
"It is not enough simply to expand resources, such as food markets in neighborhoods, without understanding and addressing the barriers individuals may face in using them," she said.
Christine believes that changing neighborhoods can help lead to healthier residents. "Modifying neighborhoods in ways that promote healthier behavior, in particular ensuring the availability of physical activity resources, may help prevent the development of type 2 diabetes," he said.
This, he admitted, is not an easy task. Communities would need to think about the health of their residents when making zoning decisions, he explained. "I am not sure this is always done," Christine said.
Still, he added, "We should be thinking about neighborhoods for potential public health action to aid in the prevention of type 2 diabetes."
Although the study found an association between type 2 diabetes rates and access to healthy food and safe exercise, it did not prove a cause-and-effect relationship.
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