IMPACT OF LIFESTYLE FACTORS ON GLYCEMIC CONTROL AMONG ADULTS WITH TYPE 2 DIABETES IN PAKISTAN: A MIXED-METHODS ORIGINAL RESEARCH

Abstract

BACKGROUND: Type 2 Diabetes Mellitus (T2DM) represents one of the most significant public health challenges in Pakistan, where the prevalence continues to rise due to modifiable lifestyle factors such as diet, physical inactivity, and limited health literacy. Despite pharmacological advances, optimal glycemic control remains largely unachieved, particularly in low- and middle-income populations where behavioral and cultural barriers persist.

OBJECTIVE: Type 2 Diabetes Mellitus (T2DM) represents one of the most significant public health challenges in Pakistan, where the prevalence continues to rise due to modifiable lifestyle factors such as diet, physical inactivity, and limited health literacy. Despite pharmacological advances, optimal glycemic control remains largely unachieved, particularly in low- and middle-income populations where behavioral and cultural barriers persist.

 METHODOLOGY: A cross-sectional, mixed-methods study was conducted from March to October 2023 at three tertiary care hospitals in Karachi, Lahore, and Peshawar. A total of 160 adults with T2DM were recruited using defined inclusion criteria. Quantitative data were obtained through structured questionnaires including a Food Frequency Questionnaire (FFQ), International Physical Activity Questionnaire (IPAQ), and the Short Test of Functional Health Literacy in Adults (S-TOFHLA). HbA1c was used as the primary outcome measure. Statistical analyses included independent t-tests, Pearson correlation, and multiple linear regression. Qualitative data were collected through semi-structured interviews with 40 participants and analyzed thematically. Ethical approval was obtained (Ref: JPMC/IRB/Diab/2023/194).

RESULTS: The mean age of participants was 53.8 ± 9.6 years, with a mean HbA1c of 7.9 ± 1.4%. High sugar intake, inadequate fiber consumption, and physical inactivity were independently associated with elevated HbA1c (p < 0.01). Participants with high health literacy showed significantly better glycemic control (HbA1c 7.1%) than those with low literacy (8.4%). Qualitative findings revealed cultural and socioeconomic barriers limiting adherence to dietary and physical activity recommendations.

CONCLUSION: Lifestyle behaviors and health literacy significantly influence glycemic outcomes in Pakistani adults with T2DM. Interventions integrating culturally sensitive dietary education, community-based physical activity, and health literacy improvement are essential for achieving sustained glycemic control.

 KEY TERMS: Cross-Sectional Studies; Diabetes Mellitus, Type 2; Diet; Exercise; Glycated Hemoglobin A; Health Literacy; Life Style; Pakistan