Diabetes & Metabolism Journal

Original Article

Lifestyle and Behavioral Interventions
Lifestyle Combination Patterns as Key Modifiable Factors for Type 2 Diabetes Mellitus Risk among Middle-Aged Korean Men: Inji Lee, Hyunjung Lim; Received February 28, 2025 Accepted October 14, 2025 Published online March 24, 2026; DOI: https://doi.org/10.4093/dmj.2025.0166 [Epub ahead of print]

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Abstract PDF PubReader ePub: Background
The increasing prevalence of type 2 diabetes mellitus (T2DM) worldwide highlights the need to understand risk factors and effective prevention strategies. Although individual lifestyle factors associated with diabetes risk have been identified, research on their collective interactions is limited. This study aimed to identify lifestyle combination patterns in middle-aged Korean men and evaluate their impact on T2DM risk.
Methods
A total of 2,332 middle-aged men without T2DM at baseline (2001–2002) from the Korean Genome and Epidemiology Study (KoGES) cohort were included. T2DM incidence was tracked through the 8th follow-up survey (2017–2018). Lifestyle combination patterns were identified using factor analysis based on sociodemographic, lifestyle, and dietary data. Cox regression was used to assess T2DM incidence across patterns.
Results
Four lifestyle combination patterns were identified: ‘Healthy Lifestyle,’ ‘Low Carb & High Protein,’ ‘High SES & Irregular Lifestyle,’ and ‘Bad Eating Habits.’ The risk of developing T2DM varied across patterns. The ‘Healthy Lifestyle’ and ‘Low Carb & High Protein’ patterns showed a slight decrease in risk in T3, but the differences were not significant. The ‘High SES & Irregular Lifestyle’ pattern was associated with a higher T2DM risk in T3 than in T1 (hazard ratio [HR], 1.25; 95% confidence interval [CI], 1.05 to 1.55), but the association was attenuated after adjustment for family history. The ‘Bad Eating Habits’ pattern showed a 1.21-fold higher risk in T3 (HR, 1.21; 95% CI, 1.01 to 1.47).
Conclusion
This study underscores the existence of distinct lifestyle combination patterns and their differential implications for T2DM risk. These findings support the need for tailored preventive strategies based on lifestyle patterns.

Reviews

Lifestyle and Behavioral Interventions
Clinically Practical and Affordable Lifestyle Modification to Prevent Diabetes Mellitus in Real Practice: Inji Lee, Minji Kang, Ji Hye Choi, Hyunjung Lim, Suk Chon; Diabetes Metab J. 2025;49(5):951-963. Published online September 1, 2025; DOI: https://doi.org/10.4093/dmj.2025.0675

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As the prevalence of type 2 diabetes mellitus continues to rise, the development of effective and sustainable prevention strategies has become a critical public health priority. Evidence from large-scale randomized controlled trials has established that lifestyle modification (LSM) programs can substantially reduce the risk of diabetes in high-risk individuals. However, routine implementation is limited by high intensity, costs, and resource requirements. We summarize major prevention trials and their effectiveness, feasibility, and limitations. Building on these insights, we introduce the Korean Diabetes Prevention Study (KDPS) as a contextually tailored model for the Korean healthcare system. The KDPS-LSM program was designed to integrate cultural and clinical relevance with practical applicability, consisting of a 6-month intensive phase of structured nutrition and lifestyle education followed by a maintenance phase to support long-term adherence. To promote sustainable change, the program incorporates the ‘10 habit’ lifestyle messages, grounded in the transtheoretical model of behavior change, which are designed for easy implementation in daily life. This review underscores the importance of developing culturally appropriate LSM programs that balance effectiveness with feasibility, and suggests that the KDPS-LSM model could serve as a useful foundation for establishing practical diabetes prevention strategies within national healthcare systems.

Citations

Citations to this article as recorded by

The Triangular Interaction Between Dietary Polyphenols, Gut Microbiota and Type 2 Diabetes
Emily Bayliss, Landri Shope, Seth Woodfin, Gretchka Mair, Matthew H. Becker, William Moore
International Journal of Molecular Sciences.2026; 27(11): 4782. CrossRef

Glycemic Index Revisited.: In Joo Kim; Korean Diabetes J. 2009;33(4):261-266. Published online August 1, 2009; DOI: https://doi.org/10.4093/kdj.2009.33.4.261

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69 Download
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Abstract PDF

The implementation of effective dietary strategies is important for diabetes management. Dietary carbohydrate is the main factor determining blood sugar level, especially in the postprandial period. Carbohydrate-rich diets can have deleterious effects on glycemic control in diabetic patients and may play an important role in the development of cardiovascular diseases. Low glycemic diets have been reported to have beneficial effects for diabetes control and cardiovascular risk factors. However, according to the American Diabetes Association recommendations for medical nutrition therapy, monitoring carbohydrate intake, whether by carbohydrate counting, exchange, or experience-based estimation, remains a key strategy for achieving glycemic control, with the use of the glycemic index and glycemic load recommended only as an auxiliary method that may provide a modest additional benefit for glycemic control over the effects observed when total carbohydrate is considered alone. Recently, an increasing amount of clinical evidence supports the efficacy of low glycemic diets for the management of diabetes. The development of practical methods to apply the glycemic index and glycemic load to the management of diabetes in clinical settings is warranted.

Citations

Citations to this article as recorded by

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