Predictors of Poor Glycemic Response to Lifestyle Intervention in Adults With Prediabetes
DOI:
https://doi.org/10.61336/jdme.0602.05Keywords:
lifestyle intervention, glycemic response, HbA1c, insulin resistance, weight loss, diabetes prevention, PrediabetesAbstract
Lifestyle intervention is an established strategy for delaying progression from prediabetes to type 2 diabetes, but individual responses vary considerably. This study evaluated baseline predictors of poor glycemic response to a structured lifestyle intervention among adults with prediabetes. A prospective observational study included 162 adults who participated in a 12-month program involving dietary modification, increased physical activity, and weight-management counseling. Glycemic response was assessed using changes in HbA1c and fasting glucose from baseline to 12 months. Poor response was defined as failure to achieve a clinically meaningful improvement in glycemic measures. Participants with higher baseline HbA1c, greater central adiposity, higher HOMA-IR, lower physical activity, and smaller weight reduction demonstrated poorer glycemic responses. In multivariable analysis, higher baseline HbA1c, greater waist circumference, and lower physical activity were independently associated with poor response. Participants with three or more baseline risk characteristics had substantially greater odds of an unfavorable response compared with those with fewer risk characteristics. These findings suggest that baseline metabolic and behavioral characteristics may help identify individuals with prediabetes who require more intensive or individualized lifestyle interventions.
References
1. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403.
2. Tuomilehto J, Lindström J, Eriksson JG, Valle TT, Hämäläinen H, Ilanne-Parikka P, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344(18):1343–1350.
3. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403.
4. Lindström J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemiö K, et al. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention. Lancet. 2006;368(9548):1673–1679.
5. Knowler WC, Fowler SE, Hamman RF, Christophi CA, Hoffman HJ, Brenneman AT, et al. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009;374(9702):1677–1686.
6. Tabák AG, Herder C, Rathmann W, Brunner EJ, Kivimäki M. Prediabetes: a high-risk state for diabetes development. Lancet. 2012;379(9833):2279–2290.
7. DeFronzo RA, Ferrannini E, Groop L, Henry RR, Herman WH, Holst JJ, et al. Type 2 diabetes mellitus. Nat Rev Dis Primers. 2015;1:15019.
8. Samuel VT, Shulman GI. The pathogenesis of insulin resistance: integrating signaling pathways and substrate flux. J Clin Invest. 2016;126(1):12–22.
9. Kahn SE, Hull RL, Utzschneider KM. Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature. 2006;444(7121):840–846.
10. American Diabetes Association Professional Practice Committee. Prevention or delay of diabetes and associated comorbidities: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1).
11. American Diabetes Association Professional Practice Committee. Facilitating positive health behaviors and well-being: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1).
12. Knowler WC, Fowler SE, Hamman RF, Christophi CA, Hoffman HJ, Brenneman AT, et al. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Diabetes Care. 2009;32(3):415–422.
