Effects of a Multicomponent Lifestyle Intervention on Behavioral and Cardiometabolic Outcomes in Adults with Type 2 Diabetes Mellitus in the Peruvian Amazon
Mónica Yenji Chia SánchezAlexander Javier Iman TorresWilson Guerra SangamaCarlos Antonio Li Loo KungSusy Karina Dávila PanduroOscar Huaman Gutierrez
A. Castillo-Paredes Jose Jairo Narrea Vargas
Aug 2026· Nutrients· Vol 18, pp. 2699· 0 citations· 47 references
Medicine
TL;DR
Participation in a three-month multicomponent lifestyle intervention was associated with greater improvements in dietary habits, physical activity, glycemic control, lipid profile, and anthropometric indicators compared with usual care among adults with type 2 diabetes mellitus in the Peruvian Amazon.
Abstract
Introduction: Lifestyle interventions are a fundamental component of type 2 diabetes mellitus management; however, evidence from real-world clinical settings regarding multicomponent interventions that simultaneously evaluate behavioral, metabolic, and anthropometric outcomes remains limited. Objective: To evaluate the effect of a multicomponent lifestyle intervention program on dietary habits, biochemical parameters, physical activity, and anthropometric indicators in adults with type 2 diabetes mellitus in the Peruvian Amazon. Methods: A quasi-experimental study with a non-randomized control group and pre–post assessments was conducted among 144 adults with type 2 diabetes mellitus (72 in the intervention group and 72 in the control group) receiving care at a hospital in the Peruvian Amazon. The three-month intervention included nutrition education sessions, practical workshops, group-based physical activity sessions involving traditional dance and Zumba, home visits, and follow-up through telephone calls and WhatsApp. Dietary habits, fasting blood glucose (FBG), glycated hemoglobin (HbA1c), lipid profile, physical activity (PA), body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) were assessed. Intervention effects were estimated using linear mixed-effects regression models adjusted for age, sex, and disease duration. Results: Compared with the control group, participants receiving the intervention experienced greater improvements in dietary habits (β = 17.85; 95% CI: 16.80 to 18.89; p < 0.001), together with greater reductions in FBG (β = −84.23 mg/dL; 95% CI: −100.45 to −68.01; p < 0.001) and HbA1c (β = −2.32 percentage points; 95% CI: −2.74 to −1.90; p < 0.001). Greater reductions were also observed in triglycerides (β = −53.68 mg/dL), total cholesterol (β = −31.73 mg/dL), BMI (β = −1.67 kg/m2), WC (β = −5.31 cm), and WHtR (β = −0.034) (all p < file0.001). PA increased to a greater extent among participants receiving the intervention (β = 3015.40 MET-min/week; 95% CI: 2769.81 to 3260.99; p < 0.001), whereas no significant between-group difference in change was observed for serum creatinine (p = 0.075). Conclusions: Participation in a three-month multicomponent lifestyle intervention was associated with greater improvements in dietary habits, physical activity, glycemic control, lipid profile, and anthropometric indicators compared with usual care among adults with type 2 diabetes mellitus in the Peruvian Amazon.
Background: Both type 2 diabetes mellitus (T2DM) and metabolic dysfunction-associated fatty liver disease (MAFLD) usually occur parallelly and share a common pathophysiological mechanism. This may include insulin resistance, dyslipidemia, and inflammation. Change in nutrition and lifestyle can help manage these conditions in a cost-effective manner. Objectives: The aim was to evaluate the effect of dietary and lifestyle intervention in patients with T2DM and MAFLD. To observe the difference in parameters like glycemic, lipid, and anthropometric profiles of subjects over the period of six months. Methods: A stratified randomized controlled trial was conducted among 300 adults with T2DM from diabetic and gastroenterology clinics in Bhubaneswar, India. Participants were categorized on the basis of the presence of MAFLD. They were randomly divided into a control group and an intervention group. Four groups with 75 participants each were created. The outcomes were measured at different intervals. It was measured at the time of start of the study and then at 1 month, 3 month, and 6 months. Results: The results were observed across all parameters in the total population. The results showed improvements over six months (p<0.001). Reduction in FBS was observed in MAFLD group. Other parameters reduced were PPBS (34.35 mg/dL), HbA1c (0.91%), ALT (21.80 U/L), AST (17.55 U/L), triglycerides (35.69 mg/dL), BMI (1.17 kg/m²), and weight (3.44 kg), with HDL rising by 4.18 mg/dL. Non-MAFLD intervention group also showed improvements, but control groups experienced only marginal changes. Intervention vs. control comparisons revealed very large effect sizes (Cohen's d: −5.05 to −5.86), with all mean differences significant at p<0.001 and 95% confidence intervals excluding zero. Conclusion: Significant improvements can be achieved with structured nutrition and lifestyle intervention in various metabolic parameters in T2DM patients. This makes a cornerstone in MAFLD and T2DM management.
Anmayee Nanda, Sambit Das, S. Patro· Genetics and Molecular Resea...· 0 citations
Background Effective type 2 diabetes (T2D) management extends beyond pharmacotherapy to include structured lifestyle interventions and continuous digital support. Accordingly, this study aimed to evaluate the effectiveness of an integrated, multicomponent 90-day healthcoach-assisted lifestyle intervention program in improving glycemic and related metabolic outcomes among patients with T2D, with assessment of benefits across adherence levels. Methods This prospective, multicenter randomized controlled trial (RCT) included 149 participants with T2D allocated to intervention (n=87) and control (n=62) groups, with subgroup stratification of intervention participants into high-adherence (≥35%; n=62) and low-adherence (<35%; n=25) groups based on median composite adherence scores. The intervention group received a structured lifestyle intervention on diet, exercise, and mental wellness alongside standard of care (SOC), while controls received SOC alone for 90 days. Glycemic, anthropometric, and diabetes distress outcomes were compared between groups and across adherence subgroups. Statistical significance was assessed for all outcomes. Results The intervention group demonstrated statistically significantly greater reductions (p<0.001) compared with the control group in glycated hemoglobin (HbA1c) (1.46 ± 1.82 vs. -0.07 ± 1.22%), fasting blood sugar (FBS) (18.83 ± 60.46 vs. -10.84 ± 55.20 mg/dL), body mass index (BMI) (0.55 ± 4.32 vs. 0.18 ± 0.78 kg/m2), body weight (1.49 ± 2.22 vs. 0.26 ± 2.57 kg), and waist circumference (1.86 ± 2.53 vs. -0.09 ± 3.93 cm). Homeostatic model assessment for insulin resistance (HOMA-IR) decreased (0.36 ± 6.63 vs. -0.27 ± 4.58), while HOMA of β-cell function (HOMA-B) improved (36.28 ± 134.32 vs. 8.72 ± 79.1), as compared with the control group. Further, diabetes-related distress significantly improved in the intervention group, shifting from moderate to low/no distress, whereas the control group approached the threshold for moderate distress (0.57 ± 0.77 vs. 0.27 ± 0.71). Participants with high-adherence showed significant reductions in HbA1c (1.7 ± 1.5 vs. 0.8 ± 1.3%), FBS (25.2 ± 60 vs. 3.1 ± 59.9 mg/dL), and weight (1.6 ± 2.3 vs. 1.4 ± 2.1 kg) compared to low-adherence participants. Conclusion This digitally delivered lifestyle intervention program produced clinically meaningful improvements in glycemic control, anthropometric measures, and diabetes related distress compared with standard care alone, with greater benefit among high adherence participants. These findings support integrating structured, coach guided digital lifestyle programs into routine T2D care, particularly in resource limited, real-world settings such as India. Clinical trial registration https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=MTA2NDAx&Enc=&userName=, identifier CTRI/2024/05/068043.
Chhavi G. Mehra, A. M. Raymond, Banshi Saboo et al.· Frontiers in Endocrinology· 0 citations
The study observed reductions in glycaemic parameters after a nutrition promotion intervention in regulating the blood glucose levels among T2DM patients and supported the importance and effect of customised nutrition counselling and health education in diabetes management to improve glycaemic control.
A. F. Fahhima, I. P. Kumar, B. Nisha· Journal of Clinical and Diag...· 0 citations
Background The Mediterranean diet (MD) is one of the dietary patterns with the strongest evidence for preventing chronic diseases and promoting healthy aging. However, adherence to it is declining among the older population in Spain, in parallel with the rise in Westernized eating patterns. In this context, community-based interventions and the development of culinary skills are emerging as promising strategies for improving dietary quality and promoting healthy habits. Objective To evaluate the effect of a multi-component intervention compared with a traditional group educational talk, on adherence to the MD and clinical parameters in people aged 60 and over. Methods An experimental, randomized, controlled study was conducted with two parallel groups, in adults aged 60 years and older in Salamanca. The main variable was adherence to the MD and clinical parameters and sociodemographic variables such as secondary variables. Results The sample comprised 130 participants. Linear mixed-effects modeling demonstrated a significantly greater improvement in MEDAS score over time in the intervention group than in the control group (group × time interaction: p = 0.027). Descriptively, the intervention group showed particularly favorable improvements in their consumption of extra virgin olive oil, fruit, vegetables and pulses, alongside a reduction in ultra-processed foods and sugary drinks. Conclusion The multi-component intervention was more effective than a traditional educational talk in improving adherence to the Mediterranean diet among community-dwelling older adults. Improvements were maintained over the three-month follow-up period.
Ana María Murillo‐Zaldívar, R. Alonso‐Domínguez, J. González-Sánchez et al.· Frontiers in Nutrition· 0 citations
Background Dietary quality and physical activity are fundamental components of glycemic management in patients with type 2 diabetes mellitus (T2DM). However, glycemic responses to lifestyle behaviors may vary across individuals, suggesting a potential role of psychological self-regulation traits. This study aimed to assess the associations of dietary quality and physical activity with glycemic indicators among hospitalized patients with T2DM and to test whether the Act with Awareness dimension of trait mindfulness moderated these associations using interaction models. Methods This cross-sectional study included 400 hospitalized patients with T2DM at the Second Affiliated Hospital of Xuzhou Medical University between December 2023 and June 2025. Dietary quality was assessed using a structured dietary score, and physical activity was evaluated according to self-reported weekly exercise duration. Trait mindfulness was measured using the Five Facet Mindfulness Questionnaire. The primary outcomes were glycated hemoglobin (HbA1c) and fasting blood glucose (FBG), both of which were natural log-transformed before regression analyses. Multivariable linear regression models were used to estimate the associations of dietary quality and physical activity with log-transformed HbA1c and FBG. Multiplicative interaction terms were then included to test the moderating role of Act with Awareness, with adjustment for demographic characteristics, lifestyle factors, BMI, diabetes duration, sleep, comorbidities, medication use, and insulin use. Results In fully adjusted models, higher dietary scores were associated with lower log-transformed HbA1c (β = -0.019, 95% CI: -0.032 to -0.005; P = 0.008) and FBG (β = -0.023, 95% CI: -0.042 to -0.003; P = 0.022). Physical activity scores were negatively associated with HbA1c (β = -0.002, 95% CI: -0.004 to 0.000; P = 0.034), but not with FBG. Significant interactions were observed between Act with Awareness and dietary score for both HbA1c and FBG, and between Act with Awareness and physical activity score for HbA1c. Conclusion Better dietary quality and higher physical activity were associated with more favorable glycemic indicators among hospitalized patients with T2DM. Act with Awareness may modify the strength of these associations. Given the cross-sectional design, these findings should be interpreted as observational associations rather than causal relationships.
Jiaxin Li, Daowen Zhang, Weiwei Zhu et al.· Frontiers in Endocrinology· 0 citations
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