Sustainable lifestyle modifications in diet and physical activity are the initial, and often the primary, component in the management of diabetes and the metabolic syndrome. An energy-prudent diet, coupled with moderate levels of physical activity, favorably affects several parameters of the metabolic syndrome and delays the onset of diabetic complications. Weight loss, albeit not an absolute prerequisite for improvement, is a major determinant and maximizes effectiveness. Adopting a healthy lifestyle pattern requires a series of long-term behavioral changes, but evidence to date indicates low long-term adherence to diet and physical activity recommendations. This calls for greater research and public health efforts focusing on strategies to facilitate behavior modification.

SUMMARY Background Lifestyle and metformin interventions reduce diabetes incidence among many adults with prediabetes. We now assess heterogeneity of their long-term effects. Methods In the Diabetes Prevention Program (DPP), a three-year randomized clinical trial in 3,234 adults with prediabetes, diabetes incidence was reduced by 58% (hazard ratio [HR]=0∙42, rate difference [RD]= −6∙2 cases/100 person-years) with intensive lifestyle (ILS) intervention and by 31% (HR=0∙69, RD= −3∙2) with metformin compared with placebo. Subsequently, the trial was continued with protocol modifications as the DPP Outcomes Study (DDPOS). Placebo was discontinued, metformin continued, and all participants offered group-based ILS. We now assess long-term persistence and heterogeneity of intervention effects on diabetes incidence. Follow-up is reported for the combined study from 31 July 1996 to 23 February 2020. The trial is registered: NCT00004992 (DPP), NCT00038727 (DPPOS). Findings During 22 years of follow-up, compared with placebo, diabetes incidence was reduced in the ILS group by 24% (HR=0∙76, 95%CI=0.68, 0.85, RD=−1·59 [−2·25, −0·93] cases/100 person-years), and in the metformin group by 17% (HR=0∙83 [0∙74, 0∙93], RD= −1·17 [−1·85, −0·49]), with corresponding increases in median diabetes-free survival of 3∙5 and 2∙5 years/person, and mean diabetes-free survival of 2∙0 [1∙2, 2∙8] and 1∙2 [0∙4, 2∙0] years/person, respectively. The overall treatment effects resulted from the large early effects during DPP. Absolute intervention effects were greater with ILS in subgroups with higher baseline fasting glucose, HbA1c, and multivariable risk indices, and with metformin in younger participants. Interpretation The large initial intervention effects resulted in sustained reductions in cumulative diabetes incidence for 22 years. Intervention effects were heterogeneous, with greater benefit in subgroups at highest risk, and with little or no effect in those with low risk of diabetes. These findings should guide precision interventions to stem the current diabetes epidemic.

<h4>Objective</h4>This systematic review and meta-analysis examined the effectiveness of social-support-based weight-loss interventions in adult populations with excess weight or obesity.<h4>Methods</h4>We performed a systematic review of randomized controlled trials that reported on the effectiveness of weight-loss interventions which incorporated a social connectedness component. To this end, we conducted a rigorous database search of MEDLINE, Embase, PsycINFO, CINAHL, Cochrane, and PubMed for relevant articles. The quality of eligible trials was evaluated by the Cochrane Risk-of-Bias2 tool. Five meta-analyses on intervention effectiveness in terms of weight loss were executed at 2-4-month assessment, 6-month assessment, end of intervention, and 3- and 6-month follow-up.<h4>Results</h4>Twenty-four trials involving couples or peers targeting weight loss in 4 919 adults with BMI ≥ 25 met inclusion criteria. Meta-analyses detected no significant effect of social-support-based weight-loss interventions at either 2-4 month or 6-month assessment. There were, however, significant effects at end of intervention [95% CI 0.39, p = 0.04] and at 3-month [95% CI 0.63, p < 0.01] and 6-month [95% CI 0.34, p = 0.05] follow-up.<h4>Conclusions</h4>There seem to be a significant effect at the end of intervention and 3- and 6-month follow-up. However, further high-quality studies are needed before drawing any clear conclusions.<h4>Trial registration</h4>PROSPERO 2020 CRD42020173696.

Introduction In recent decades, the prevalence and incidence of type 2 diabetes mellitus (T2DM) have increased rapidly and represent a significant public health problem worldwide. Long-term T2DM is associated with microvascular complications such as retinopathy, nephropathy, and neuropathy. Prediabetes is a state of hyperglycemia with blood glucose levels higher than normal but lower than the diabetes threshold. Several studies have demonstrated the effectiveness of lifestyle interventions that resulted in a 40% to 70% reduction in diabetes mellitus in adults with prediabetes. These interventions focused on increased physical activity and dietary changes that were able to prevent or delay the onset of T2DM in prediabetes. However, most review studies focused on interventions to prevent T2DM in high-risk groups such as obesity. There was a limitation of reports related to prediabetes. Nevertheless, it remains a high-risk condition for the development of T2DM with a conversion rate of 5% to 10% per year. Therefore, the aim of this study was to review the current evidence on intervention studies aimed at reducing the incidence of type 2 diabetes in prediabetes. Method The researcher conducted a literature search of common online databases such as Medline, Google Scholar, and Cochrane Library between January 2011 and December 2021. Result The intervention for the prevention of T2DM in prediabetes consisted of a lifestyle intervention, a nutritional supplementation intervention, and a pharmacological intervention Conclusion Several studies suggest that T2DM in prediabetes can be prevented by lifestyle modification and pharmacological interventions, or a combined intervention. However, further interventions may be needed to confirm this.

Background: Emerging research has examined electronic and mobile health (e/mHealth) technologies for weight loss and manage of type 2 diabetes mellitus (T2DM), but few studies have focused specifically on ways to target social support behaviors that have proven to be effective. While gamifying an mHealth behavioral weight loss intervention holds promise to promote and sustain social support, there has been very little research in this area. The mobile Lifestyle Intervention for Food and Exercise study (mLife) was designed to test if receiving points for social support is an effective way to promote sustained weight loss. Objective: To describe the design of the 12-month mLife study, a randomized clinical trial, which compares the differential long-term effect of a behavioral weight loss program with and without gamification among adults with overweight or obesity. Methods: Participants (target N=240) in two consecutive cohorts were randomized to either the mLife+points or mLife group. The weight loss intervention for both groups included diet and physical activity (PA) recommendations, education, daily diet logging, visualization of PA and body weight readings captured with a wearable tracker and e-scale, and facilitation of social interaction among participants. The mLife+points group earned points for social support activities. Remote follow-up assessments of weight, anthropometric measures, diet (24h dietary recalls), PA, social support provision, receipt and enjoyment, factors driving self-monitoring adherence and study compliance/responsiveness occurred at 6 and 12-months post-baseline. Conclusion: The mLife study informs the expansion of gamification within mHealth programs to enhance social support provision and receipt during weight loss.

<h4>Background</h4>Despite the evidence for the efficacy of lifestyle interventions for type 2 diabetes prevention, there remains a gap in translating this evidence-based practice into real-world settings.<h4>Aims</h4>To summarize current evidence regarding the relationship between participant characteristics, intervention components, and the effect of lifestyle interventions for individuals with prediabetes.<h4>Methods</h4>The initial search of PubMed, Embase, the Cochrane Library, and Web of Science was performed on 6th December 2023 and was subsequently updated on 5th October 2025. Randomized controlled trials on lifestyle interventions (diet and/or physical activity), compared to usual care, no intervention, or wait-list control, in adults with prediabetes were eligible. Outcomes included the incidence of type 2 diabetes and normoglycemia, fasting plasma glucose (FPG), 2-h plasma glucose, hemoglobin A1c (HbA1c), fasting insulin (FI), and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Random-effects meta-analyses were performed to estimate relative risks (RRs) and mean differences. Subgroup analyses and meta-regressions were conducted by participant characteristics and intervention components.<h4>Results</h4>Seventy-seven studies (n = 22,629 participants) were included. Greater weight loss (%) was associated with larger reductions in diabetes incidence (β = 0.07 [0.02, 0.12], p = 0.010). Achieving ≥ 5% (vs. < 5%) weight loss was associated with higher reversion rates to normoglycemia (RR = 1.80 [1.55; 2.08] vs. 1.32 [1.03; 1.70]; p_subgroup = 0.036). Interventions with supervised exercise training more effectively reduced diabetes incidence than those without this component (RR = 0.40 [0.24; 0.65] vs. 0.69 [0.63; 0.76]; p_subgroup = 0.031). Younger participants showed greater improvements in FPG, HbA1c, FI, and HOMA-IR. Higher baseline HbA1c levels were associated with a greater reduction in HbA1c but a smaller FI improvement.<h4>Linking evidence to action</h4>This meta-analysis provides valuable insights into the implementation of diabetes prevention programs. Weight loss is a critical determinant for diabetes prevention, and weight loss goal setting and progress monitoring are recommended. Adding supervised exercise sessions can enhance the program's effectiveness. Early interventions for younger individuals with lower HbA1c levels may prevent diabetes more effectively.<h4>Trial registration</h4>PROSPERO (CRD42024486361).

Background: Seven landmark randomised controlled trials, with some that began as early as the 1990s, observed the prediabetic state, namely, impaired glucose tolerance and impaired fasting glucose conditions, against the impact of lifestyle interventions such as physical activity, to prevent or delay the onset of type 2 diabetes mellitus. In addition to the landmark trials, this systematic review examines 14 studies that retained a focus on prediabetic individuals and measured the efficacy of physical activity on improving glucose tolerance. Results: Type, duration and intensity of structured physical activity can have unique benefits to prediabetic individuals. It is posited that diabetes prevention programmes must target prediabetic individuals as belonging to a high-risk group, separate and distinct from those identified with overall risk factors. While the transition from prediabetes to type 2 diabetes mellitus is not completely deterministic, the conversion rate is phenomenally higher among those with impaired glucose tolerance than those with normal glucose levels. Conclusion: Tenets of health behaviour models do support inferences that prediabetic individuals are potentially more inclined to weighing the risks and benefits of progressive illnesses and would therefore be more receptive to active participation in interventions. More research is required to develop evidence-based diabetes prevention programmes linked to structured physical activity intervention.

Type 2 diabetes mellitus (T2DM) represents a pervasive global health challenge, with projections indicating a rise to 693 million cases by 2045 and an immense associated financial burden. This narrative review examines the effectiveness of non-pharmacological, lifestyle-oriented interventions in managing and mitigating T2DM. Electronic databases such as PubMed and Google Scholar were systematically searched for relevant reviews, meta-analyses, and original research. The analysis synthesizes evidence on structured dietary regimens, including the Mediterranean and DASH diets. It also highlights their role in improving glycemic control and insulin sensitivity through mechanisms such as modulating dietary fiber, glycemic load, and gut microbiota. The review further establishes that the synergistic combination of these dietary patterns with regular physical activity and resultant modest weight loss (5-10%) directly counteracts core pathophysiological pathways like insulin resistance and β-cell dysfunction. Beyond nutrition and exercise, the integral roles of behavioral psychology, sleep quality, and tobacco abstinence are examined as critical components of a holistic management strategy. The evidence underscores that these lifestyle interventions are not merely adjuncts but fundamental to effective diabetes care. This synthesis aims to provide a comprehensive resource for researchers and clinicians, facilitating the integration of these dietary and lifestyle strategies to combat the growing global diabetes epidemic.

The purpose of this essay is to review available evidence on lifestyle, pharmacological and herbal remedies influence on the prevention or delay of the onset of type 2 diabetes and adapting these lessons from clinical trials to clinical practice. A Medline literature search from 1997-2006 was performed to identify articles on the prevention or delay of type 2 diabetes in adults. The limits were practical guidelines, systematic reviews, randomized controlled trials (meta-analyses), as full text articles or abstracts, and with no limits for the period searched. Different trials and systematic reviews have revealed that pharmacological and lifestyle interventions can reduce the rate of progression to type 2 diabetes in people with impaired glucose tolerance. The overall goal for diabetes prevention is to reach and maintain an active, healthy weight with a tendency toward a hypo-caloric diet. Pharmacological interventions also reduced diabetes risk. However, lifestyle changes were more effective and are recommended as first-line strategy. For pharmacological interventions adverse effects need to be fully understood to enable the potential harms and benefits to be assessed. Therefore, better approach to patients for lifestyle changes should be achieved through a structured program in order to delay or prevent type 2 diabetes. Multidisciplinary healthcare teams may provide more intensive counseling and increase the contact the patient has with the overall healthcare system.

ABSTRACT The prevalence of diabetes mellitus is increasing and is related to sedentary lifestyles and obesity. Many studies were published on the effect of lifestyle interventions on glucose regulation and delay the onset of diabetes in adults with impaired glucose tolerance (IGT) or prediabetes. This study aimed to investigate the role of lifestyle interventions in individuals with IGT or prediabetes using a meta-analytic approach. PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases were searched from their inception up to January 2020 to select eligible randomized controlled trials (RCTs). The weighted mean difference (WMD; for fasting plasma glucose (FPG) and 2-hour plasma glucose (2hPPG)) or relative risk (RR; for the risk of diabetes) with 95% confidence interval (CI) were calculated for pooled effect estimates using the random-effects model. Thirteen RCTs involving 3376 individuals with IGT or prediabetes were selected for this meta-analysis. The results showed that lifestyle interventions were associated with lower FPG (WMD: -0.14; 95% CI: -0.24 to -0.05 mmol/L; p=0.004) and 2hPPG (WMD: -0.66; 95% CI: -1.12 to -0.20 mmol/L; p=0.005) in adults with IGT or prediabetes. Moreover, the risk of diabetes was significantly reduced in individuals who received lifestyle interventions (RR: 0.75; 95% CI: 0.60-0.95; p=0.015). Lifestyle interventions could help improve glucose dysregulation and prevent the progression of diabetes in adults with IGT or pr

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