Comprehensive lifestyle modifications delay diabetes progression

Abstract

Background: Diabetes mellitus (DM) is the most common endocrine disease in the world. The majority of patients with DM (90–95%) develop type 2 diabetes mellitus. This type of DM arises through the gradual loss of insulin secretion which may be partly related to obesity, physical inactivity, pancreatic beta-cell function decline and eventual hyperglycemia. The hypothesis of this study was to investigate whether lifestyle modification delay diabetes progression or not. Methods: A cross-sectional observational study was conducted at the department of pathology of Dhaka National Medical College from July 2025 to October 2025. Total 148 subjects were classified into two groups. Well controlled DM patients (HbA1c less than or equal 6.5) were considered as an unknown stage (n=85) and poor controlled DM patients (HbA1c greater than or equal 8) were considered as stage 1-3 (n= 63).  Purposive sampling was done according to availability of patients. Ethical clearance was obtained from the appropriate authority to get permission to collect data. The collected data were entered into the computer and analyzed by using SPSS (version 20.1) Results: Patients with stage 1-3 tended to be older (mean age 47.9 vs. 44.9 years, p= 0.063). Alcohol use was significantly more prevalent in stage 1-3 (52.7% vs. 47.3%, p=0.014), while physical activity pattern was similar across groups (p=0.615 active vs. inactive comparisons). Pregnancy/lactation status among female participants also didn’t differ by staging (57.9% unknown stage vs. 42.1% stage 1-3, p=0.6). Patients with a low-risk profile (non-smokers, non- drinkers, and physically active) were significantly more prevalent in the Unknown Stage (32.2%) compared to Stage 1-3 (27.0%, p=0.04). No significant differences were observed for other lifestyle combinations (all p>0.05), though trends suggest higher rates of high-risk behaviors (smoking + alcohol + inactivity) in Stage 1-3 patients (24.3% vs. 18.6%, p= 0.34). Multivariable logistic regression confirmed older age (per decade: aOR=1.32, 95% CI:1.08- 1.61, p= 0.01) as independent predictors of Stage 1-3 diabetes, while physical activity was protective (aOR=0.61, 95% CI: 0.38 -0.98, p= 0.04). Male gender showed no significant association (p= 0.62). These results, derived through maximum likelihood estimation, demonstrate that modifiable lifestyle factors significantly influence diabetes progression.  Conclusion: Physically active patients were significantly more prevalent in the Unknown Stage compared to Stage 1-3. These findings support that comprehensive lifestyle modifications may delay diabetes progression.