Type 2 Diabetes Mellitus (T2DM) represents a significant and escalating public health challenge globally, with over 450 million people currently living with the condition, a figure projected to rise dramatically in the coming decades. T2DM is characterized by a progressive loss of insulin sensitivity and beta-cell dysfunction, resulting in sustained hyperglycemia. If left untreated, these metabolic abnormalities lead to an array of debilitating complications, including macrovascular conditions such as myocardial infarction and stroke, and microvascular issues like diabetic retinopathy, nephropathy, and neuropathy. These complications not only significantly increase mortality rates but also impose substantial burdens on healthcare systems, especially in low- and middle-income countries where resources are often limited [1-3].

The economic impact of T2DM management is mind-boggling. Much of the money spent in the health care system goes to treating complications, instead of treating the underlying causes of disease. This highlights the urgent need for preventive strategies that may slow down disease progression by means of lifestyle changes. While pharmacological treatments, including the use of oral hypoglycemic agents and insulin therapy, serve as key pillars of T2DM management, they provide a poor solution for unmasking the underlying behavioral and environmental determinants of disease onset and unfolding. As such, lifestyle adjustments, where dietary patterns, exercising, weight control, and behavioral therapies, play critical roles in T2DM prevention and management [4-6].

Dietary practices are a key determinant of glycemic control and metabolic health. This leads to insulin resistance and worsens hyperglycemia which is observed in unhealthy diets high in refined carbohydrates and saturated fats, hard fats, and added sugars. In contrast, there is evidence that better dietary habits, as seen from the Mediterranean diet approach or low-carbohydrate diets can help with glycemic control and reduce the risk of cardiovascular complications. The evidence demonstrates that dietary behavior change is most effective when addressed within the context of an individual’s cultural and socioeconomic context, emphasizing the need for personalized nutrition counseling [7-9]. Another significant risk factor for the global burden of T2DM is physical inactivity. A prolonged sedentary lifestyle, which involves long duration of sitting and little physical activity, also increases insulin resistance and promotes obesity, an important risk factor for T2DM. Regular aerobic and resistance exercise significantly improves insulin sensitivity, reduces HbA1c, and boosts cardiovascular fitness. New evidence also supports the efficacy of high-intensity interval training (HIIT), which can produce marked metabolic changes over shorter exercise durations and may be practical for time-deprived individuals [10-13].

Obesity, a major modifiable risk factor for T2DM, underscores the importance of weight management in disease prevention and control. Even modest weight loss of 5-10% has been shown to significantly improve glycemic control, reduce insulin resistance, and lower the risk of cardiovascular complications. Intensive lifestyle interventions focusing on caloric restriction and structured physical activity are foundational for achieving sustainable weight loss. For individuals with severe obesity, bariatric surgery has emerged as a highly effective option, leading to T2DM remission in a significant proportion of patients. However, the invasive nature of these procedures and their associated risks necessitate careful patient selection and long-term follow-up [14-17]. The role of behavioral interventions in supporting lifestyle changes cannot be overstated. Psychological factors, including stress, depression, and low self-efficacy, often act as barriers to adopting and maintaining healthier habits. Cognitive Behavioral Therapy (CBT), motivational interviewing, and peer support programs have been effective in enhancing adherence to lifestyle modifications. Digital health technologies, such as mobile applications and wearable devices, further augment these interventions by providing real-time feedback, goal tracking, and personalized recommendations. These tools not only enhance patient engagement but also offer scalable solutions for addressing the global burden of T2DM [18-20]. Public health strategies also play a critical role in promoting lifestyle changes at the population level. Policy initiatives aimed at improving access to healthy foods, creating safe spaces for physical activity, and increasing awareness about the benefits of lifestyle modifications can significantly reduce the prevalence and impact of T2DM. Community-based programs, such as nutrition education workshops and group exercise sessions, have shown promise in empowering individuals to take control of their health. Additionally, workplace wellness programs and school-based interventions can foster healthier behaviors across different age groups and settings, further amplifying the impact of lifestyle changes [21-24].

This systematic review aims to consolidate the evidence supporting the role of lifestyle interventions in managing T2DM. By examining the efficacy of dietary modifications, physical activity, weight management, and behavioral interventions, this review provides actionable insights for healthcare providers, policymakers, and researchers. The findings underscore the need for culturally sensitive, patient-centered approaches to lifestyle modifications and highlight the importance of integrating these strategies into standard clinical care. Furthermore, the review identifies gaps in the current research, paving the way for future studies aimed at optimizing the implementation and scalability of lifestyle interventions globally

This systematic review was conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure methodological rigor and transparency. A comprehensive literature search was carried out using PubMed, Scopus, and Web of Science databases to identify relevant studies published between January 2000 and January 2025. The search terms employed included "Type 2 Diabetes Mellitus," "lifestyle changes," "dietary interventions," "physical activity," "weight management," "behavioral interventions," and "glycemic control." To enhance the comprehensiveness of the search, the reference lists of included articles were also reviewed.

Studies were included if they were randomized controlled trials (RCTs), longitudinal cohort studies, observational studies, or meta-analyses evaluating the effects of lifestyle changes on glycemic control and other T2DM-related outcomes. Eligible studies involved adult populations diagnosed with T2DM and reported outcomes such as HbA1c levels, weight changes, or incidence of complications. Studies not available in English, lacking full-text accessibility, or focusing exclusively on type 1 diabetes were excluded. Data extraction was performed systematically, focusing on study design, sample size, type of intervention, duration of follow-up, primary outcomes, and key findings. Any discrepancies during data extraction were resolved through discussion and consensus among the reviewers to ensure accuracy and reliability [25-27].

PRISMA Flow Diagram

A PRISMA flow diagram summarizing the selection process for studies included in this review is presented below:

Diet and lifestyle related tips to control or prevent type-2 diabetes mellitus

Dietary Modifications

Dietary modifications are a cornerstone of T2DM management, with robust evidence demonstrating their efficacy in improving glycemic control, reducing insulin resistance, and mitigating cardiovascular risks. Numerous dietary patterns have been studied, including low-carbohydrate diets, Mediterranean diets, and Dietary Approaches to Stop Hypertension (DASH) diets. Low-carbohydrate diets have garnered significant attention due to their ability to reduce postprandial glucose spikes and improve HbA1c levels. A comprehensive meta-analysis conducted in 2023, which included 25 randomized controlled trials involving over 5,000 participants, reported that low-carbohydrate diets led to an average reduction in HbA1c levels by 0.6% over a six-month period. These diets also demonstrated improvements in lipid profiles, particularly in reducing triglycerides and increasing HDL cholesterol levels [28-30].

The Mediterranean diet, characterized by a high intake of fruits, vegetables, whole grains, nuts, seeds, and olive oil, has consistently shown benefits in managing T2DM. Its anti-inflammatory and antioxidative properties contribute to improved glycemic control and reduced cardiovascular risks. Studies have reported that adherence to the Mediterranean diet is associated with a 30% reduction in cardiovascular events among individuals with T2DM. Similarly, the DASH diet, originally designed to manage hypertension, has been effective in improving insulin sensitivity and reducing HbA1c levels in diabetic patients [31-33].

Emerging dietary strategies such as intermittent fasting and time-restricted eating have also shown promise. Intermittent fasting, which involves alternating periods of fasting and eating, has been linked to improved insulin sensitivity and significant weight loss. For instance, a 2021 study demonstrated that intermittent fasting led to a 1.2% reduction in HbA1c levels and a 7% decrease in body weight over a 12-week period. The evidence highlights the need for personalized dietary counseling that considers cultural, socioeconomic, and individual preferences to ensure adherence and long-term success [34-36].

Physical Activity

There is no doubt that all the findings show the importance of physical activity on insulin sensitivity and glycemic control and cardiovascular prevention makes physical activity a cardinal in the management of T2DM. Walking, jogging, swimming and cycling are well-studied forms of aerobic exercise that lower HbA1c and improve metabolic health. According to a systematic review published in 2021 that included 30 studies, aerobic exercise resulted in a mean decrease of 0.8% in HbA1c over 12 months. Resistance training, which builds muscle strength through weight lifting and the like, complements aerobic activity by increasing muscle glucose uptake and improving body composition. Studies have mentioned that aerobic and resistance training combination can control glycemia better than either modality alone [37-39].

However, alternatives that may help achieve better glycaemic control or metabolic profile in those at risk or with existing diabetes are being evaluated, such as high-intensity interval training (HIIT). High-intensity interval training (HIIT) is a time-efficient method of improving cardiovascular fitness and glycemic control in the individual, providing short periods of intense exercise interspersed with recovery periods. HIIT was reported to achieve a 1% reduction in HbA1c levels and a 15% increase in VO2 max in six months (a study with 200 participants). While effective, this same intensity of HIIT could prove a challenge for some patients, which underscores the need to adapt exercise plans to one of the most common comorbidities. For instance, introducing physical activity into ordinary practices, the use of pedometers for steps and group fitness has been supported as a means to improve adherence and maintain long-term effects [40-42].

Weight Management

Obesity is a major modifiable risk factor for T2DM, and weight reduction is a critical goal in its management. Studies have consistently demonstrated that even modest weight loss of 5-10% can significantly improve glycemic control, reduce insulin resistance, and lower the risk of cardiovascular complications. A landmark trial conducted in 2018 highlighted that intensive weight management programs, which included meal replacements and structured counseling, achieved T2DM remission in 46% of participants after 12 months [43-45].

Bariatric surgery has revolutionized the management of obesity-related T2DM, particularly in individuals with severe obesity. Procedures such as gastric bypass and sleeve gastrectomy have shown remarkable outcomes, with T2DM remission rates ranging from 60% to 80% within the first year post-surgery. However, bariatric surgery is not without risks and is generally reserved for individuals with a body mass index (BMI) above 35 kg/m² who have failed to achieve glycemic control through conventional methods. Lifestyle interventions focusing on caloric restriction and increased physical activity remain foundational for sustainable weight management and long-term health benefits [46-47].

Monitor Blood Sugar Levels Closely

Monitoring blood sugar levels at regular interval helps in keeping track of the Disease status, i.e. whether it is under control or going out of control. It is essential to keep the blood sugar levels under control to prevent the complications and damage to the vital organs (Heart, Kidneys, Eyes, Nerves).

Reduce the quantity of Refined Carbohydrates

Reduce the quantity of refined carbohydrates such as Table sugar (Sucrose), Sugar-sweetened beverages, Chocolates, Ice creams, White Bread, Maida (Bleached flour) and its products, Mithai, etc. It is essential to prevent frequent spikes in blood sugar levels, especially when one is suffering from Diabetes. It also increases the risk of obesity and metabolic syndrome, which is itself a risk factor for developing insulin resistance and suffering from type-2 Diabetes.

Eat the right type of Carbohydrates

Carbohydrates are one of the essential dietary components, we cannot avoid them entirely. It necessary to eat more of complex carbohydrates such as fruits, vegetables (Provide a sufficient amount of dietary fibres), whole grains, etc. than eating the refined ones (Maida, Sugar, etc.)

Choose foods having low Glycemic Index

The Glycaemic index is a measure of how quickly a food which we have eaten, increases our blood sugar levels. Foods having a low glycaemic index undergoes slow digestion and absorption.  It does not cause a rapid rise in blood sugar levels, which can be beneficial in keeping Diabetes under control. Also, it decreases the chances of developing insulin resistance and that of suffering from Type-2 Diabetes mellitus in those who are at risk. The foods having low glycaemic index are:

Fruits and vegetables

Whole grains, non-polished rice, etc.

High protein food (meat, egg, fish, pulses, etc.)

Food containing healthy oil (Olive oil, nuts, Omega-3 rich food)

  Increase dietary fiber intake

All types of dietary fibres can slow down the absorption of sugar and fats from food, therefore help in preventing spikes in blood sugar levels (low glycaemic index). It reduces the risk of developing insulin resistance and the chances of suffering from diabetes mellitus.

It also helps in keeping blood glucose levels under control in those who are suffering from Diabetes. It slows down the digestion and provides bulk, which reduces the food intake and prevents weight gain, obesity. Which, otherwise can be an additional risk factor.

Maintain a healthy weight

Being overweight or obese is associated with excess deposition of fats in our body. Excess body fat creates inflammation which, increases the risk of developing insulin resistance and subsequent chances of suffering from Diabetes mellitus.

In a person suffering from diabetes, obesity can further weaken the action of the hormone insulin and worsen the blood sugar control.  It is thus, essential to lose excess fat and maintain healthy body weight.

 Limit the quantity of food

Persistent Overeating is associated with excess caloric consumption, along with an excess of fats and carbohydrates (Mostly refined sugar). It increases the risk of obesity, insulin resistance and subsequent chances of developing Diabetes mellitus.

Excess consumption of refined carbohydrates during frequent overeating increases the chances of Spikes in blood sugar levels and impaired blood sugar control in a Diabetic person.

 Do regular exercise and avoid sedentary lifestyle

Being active, doing regular exercise (As per one’s capacity and the instruction from a physician if one is diabetic) rather than sitting at one position for far too long can be beneficial in many ways. It helps in losing extra weight and preventing obesity. It also reduces the chances of developing insulin resistance. Sugar from the blood gets effectively utilized by the exercising muscles and tissues as a source of energy, which helps in keeping levels of sugar in the blood within control. Thus, it helps in preventing Diabetes Mellitus.

  Drink sufficient water

Not drinking enough water for a long time can lead to chronic dehydration. During chronic dehydration, the body releases certain hormones/chemicals (Vasopressin), which prompts our kidney to retain water by decreasing the volume of urine. Thus, it reduces the amount of excess of blood sugar that is removed through the urine.

It also stimulates the liver to produce more Sugar (Glucose) in the body. Both these mechanisms can contribute to a sustained rise in blood sugar levels. It can lead to the risk of developing insulin resistance and further that of suffering from Diabetes Mellitus. Thus, it is vital that we drink sufficient water and keep ourselves hydrated.

Manage chronic stress

Chronic stress induces the secretion of certain chemicals/hormones (cortisol, epinephrine, etc.) in the body, which decreases the secretion of Insulin and raises the levels of blood sugar in the body. There also happens the increased deposition of fatty tissues within the body.

Excess fatty tissues create inflammation and reduce the function of the hormone insulin (Insulin resistance). Thus, it either increases the chances of developing Diabetes mellitus in those who are at risk or worsens the blood sugar control in those are already suffering from Diabetes mellitus.

Get enough sleep

Getting less than a sufficient amount of sleep during the night can make us feel tired. It makes our body to try and get energy by eating the food rich in sugar. It can be responsible for increasing the levels of blood sugar, and risk of weight gain, obesity (excess caloric consumption). It also worsens glucose tolerance due to the development of insulin resistance, which together contributes to the increased risk of Diabetes Mellitus.

Optimize vitamin-d levels

Optimum vitamin D levels improve the insulin sensitivity in the body, thus, reduce the risk of insulin resistance. The body can optimally metabolize and utilize the sugar, thus keeping the blood sugar levels within control, which reduces the risk of developing Diabetes mellitus

Avoid eating junk food or processed food

When we overeat junk food or processed food, we are consuming an excess amount of refined carbohydrates, fats and salt. All these ingredients can increase the risk of weight gain and obesity, insulin resistance and subsequent development of Diabetes mellitus or worsen the blood glucose levels in a Diabetic person. Its thus, advisable to avoid these kinds of foods or at least reduce their quantity and frequency in the regular diet.

Quit smoking

Avoid or at least reduce the alcohol intake

The findings from this systematic review underscore the pivotal role of lifestyle interventions in the effective management of Type 2 Diabetes Mellitus (T2DM). While pharmacological therapies remain essential, lifestyle changes provide complementary benefits that address the root causes of the disease. Dietary modifications, including low-carbohydrate, Mediterranean, and DASH diets, have consistently demonstrated the ability to improve glycemic control, enhance lipid profiles, and reduce the risk of cardiovascular complications. These dietary approaches not only offer metabolic advantages but also promote long-term adherence when tailored to individual cultural and socioeconomic contexts [28-30, 31-33]. Personalized nutrition counseling remains a cornerstone of dietary interventions, ensuring that patients can adopt sustainable habits that align with their lifestyles.

Physical activity is the other pillar of T2DM management, it has significant impacts on insulin sensitivity, glycemic control, and global metabolic health. Glycemic control and cardiovascular fitness are significantly improved with aerobic and resistance exercise, as well as novel approaches like high-intensity interval training (HIIT). To promote adherence and long-term sustainability, the incorporation of physical activity into daily routines, along with behavioral treatments to counter psychological barriers, is essential. While benefits have been demonstrated, barriers including low motivation, inability to access exercise facilities, and physical limitations in the older adult population necessitate exercise programs that are tailored to overcome these barriers [37–39, 40–42].

Weight management is an important aspect of lifestyle interventions owing to the close relationship between obesity and T2DM. Irrespective of the type of intervention employed to lose weight, evidence from several studies has shown that even modest weight loss can lead to significant improvement in glycemic control and a reduction in complication risk. Intensive lifestyle modifications based on reduced calorie intake and increased physical activity have been shown effective for substantial weight loss and, in some patients, disease remission. Invasive bariatric management can be an effective long-term option for patients with advanced obesity and results in T2DM resolution in many instances. Based on the associated risks and costs, though, careful patient selection and long-term follow-up are needed [43-45, 46-47].

Therapeutic interventions (CBT, motivational interviewing, peer support, etc) are important options to cope with psychological and behavioral barriers to lifestyle change. Digital health technologies, including mobile apps and wearable devices, have also transformed the delivery of behavioral interventions, offering patients real-time feedback, goal tracking, and personalized recommendations. They are valuable components of structured lifestyle intervention programs as they contribute to patient engagement and promote long-term behavior change [18-20].

Despite the robust evidence supporting the efficacy of lifestyle interventions, several challenges persist in their implementation. Socioeconomic barriers, cultural differences, and disparities in healthcare access often limit the adoption and sustainability of these interventions. Public health strategies, including policy initiatives aimed at improving access to healthy foods, promoting physical activity, and increasing awareness, are essential to address these barriers. Community-based programs and workplace wellness initiatives also offer scalable solutions that can foster healthier behaviors at the population level [21-24].

Moreover, healthcare systems must prioritize a multidisciplinary approach to care that incorporates dietitians, psychologists, exercise physiologists, and primary care physicians to provide comprehensive and individualized care. Integrating behavioral science into clinical practice can help address the psychological and social determinants of health, which often influence patients' ability to adopt and maintain lifestyle changes. For example, motivational interviewing techniques and culturally tailored interventions have shown promise in overcoming resistance to change and improving adherence among diverse patient populations [18-20].

Another promising avenue is the use of emerging technologies such as telemedicine and wearable devices, which provide real-time monitoring and support for patients. These technologies not only enhance patient engagement but also offer scalable solutions for delivering lifestyle interventions to remote and underserved populations. Studies have demonstrated that digital health tools can improve glycemic control, promote weight loss, and increase physical activity levels, making them valuable additions to traditional care models [40-42].

Future research should also focus on long-term studies to evaluate the sustainability and cost-effectiveness of lifestyle interventions. While short-term benefits are well-documented, understanding how these interventions impact long-term outcomes such as disease progression, quality of life, and healthcare costs is crucial for informing policy and clinical practice. Additionally, research should explore the role of precision medicine in tailoring interventions based on genetic, metabolic, and behavioral profiles, which could further enhance the efficacy of lifestyle changes in managing T2DM [28-30].

Lifestyle changes are integral to the effective management of Type 2 Diabetes Mellitus (T2DM), offering significant benefits in glycemic control, weight management, and cardiovascular health. Evidence from this review underscores the importance of individualized, culturally sensitive interventions that address the unique needs and preferences of patients. Dietary modifications, physical activity, weight management, and behavioral interventions collectively form the foundation of a comprehensive approach to T2DM management. While challenges such as socioeconomic barriers and healthcare disparities persist, the integration of public health strategies and digital health technologies offers promising avenues to enhance the accessibility and sustainability of lifestyle interventions.

Future research should focus on addressing these barriers and optimizing the scalability of lifestyle interventions. By prioritizing patient-centered approaches and leveraging advancements in technology, healthcare systems can improve outcomes for individuals living with T2DM while reducing the global burden of this chronic disease. Comprehensive, multidisciplinary efforts are essential to empower patients and foster long-term adherence to lifestyle changes, ultimately improving quality of life and reducing the prevalence of diabetes-related complications

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