Multifactorial Model of Glycemic Control: Socio-Demographic, Dietary, and Behavioral Determinants among Patients with Type 2 Diabetes – A Cross-Sectional Study
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Background: Type 2 diabetes mellitus (T2DM) is a major public health issue influenced by factors beyond medication. Dietary habits, lifestyle behaviors, and socio-demographic characteristics have shown significant impacts on glycemic control. However, integrated models examining these factors collectively remain limited. This study aims to evaluate the combined influence of these variables among T2DM patients.
Objective: This study aims to evaluate the combined influence of these variables among T2DM patients.
Methodology: This cross-sectional study included 250 patients with Type 2 Diabetes. The data was gathered through in-person interviews with patients through questionnaires distributed on the basis of axes.
Result: The mean of age 53.3±9.8 (with range; 32-75) years while the mean of BMI is 30.98±5.88 (with a range of 18.55-52.79).The results of the study reveal that for more than half of patients, their duration of disease with T2DM was 1-5 years (50.8%),The high percentage (76.8%) of the patients with T2DM have any first-degree relatives with diabetes. A very high percentage (86.4%) of the patients with T2DM have high levels of HbA1c. The mean of HbA1c was 8.97±2.237 (with a range of 5.7-14.9).The study results of demonstrated that most patients suffering from diabetes (67.6%) practiced light physical activity, such as slow walking and light housework.A very high percentage (99.6%) of diabetics eat three meals a day. 54.8% of patients suffering from diabetes eat snacks and sugary pastries between meals.Also,the findings of this study indicate that 82.0% of patients follow unhealthy food patterns. Finally, the results found there were negative correlations between HbA1c and the overall food pattern scores (-0.713).
Conclusion: The study results show a statistically significant relationship between Socio-demographic, dietary habits and lifestyle behaviors variables and the incidence and control on the type 2 diabetes mellitus (T2DM).
1. Sabea WS, Hassoun SM, Hussein AA. ASSOCIATION BETWEEN SOCIO-DEMOGRAPHIC, HEALTH CHARACTERISTICS AND TYPE 1, TYPE 2 DIABETIC CASES IN GOVERNORATE OF BABYLON, IRAQ. Glob J Public Heal Med. 2022;4(1):608–17.
2. Noshad S, Afarideh M, Heidari B, Mechanick JI, Esteghamati A. Diabetes care in Iran: where we stand and where we are headed. Ann Glob Heal. 2015;81(6):839–50.
3. Abdul Basith Khan M, Hashim MJ, King JK, Govender RD, Mustafa H, Al Kaabi J. Epidemiology of type 2 diabetes—global burden of disease and forecasted trends. J Epidemiol Glob Health. 2020;10(1):107–11.
4. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047–53.
5. Davies MJ, D’Alessio DA, Fradkin J, Kernan WN, Mathieu C, Mingrone G, et al. Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2018;41(12):2669–701.
6. Galicia-Garcia U, Benito-Vicente A, Jebari S, Larrea-Sebal A, Siddiqi H, Uribe KB, et al. Pathophysiology of type 2 diabetes mellitus. Int J Mol Sci. 2020;21(17):6275.
7. Afshin A, Sur PJ, Fay KA, Cornaby L, Ferrara G, Salama JS, et al. Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2019;393(10184):1958–72.
8. McGovern A, Tippu Z, Hinton W, Munro N, Whyte M, de Lusignan S. Comparison of medication adherence and persistence in type 2 diabetes: A systematic review and meta‐analysis. Diabetes, Obes Metab. 2018;20(4):1040–3.
9. Standl E, Khunti K, Hansen TB, Schnell O. The global epidemics of diabetes in the 21st century: Current situation and perspectives. Eur J Prev Cardiol. 2019;26(2_suppl):7–14.
10. Young-Hyman D, de Groot M, Hill-Briggs F, Gonzalez JS, Hood K, Peyrot M. Erratum. Psychosocial Care for People With Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care 2016; 39: 2126–2140. Diabetes Care. 2017;40(2):287.
11. Forouhi NG, Misra A, Mohan V, Taylor R, Yancy W. Dietary and nutritional approaches for prevention and management of type 2 diabetes. Bmj. 2018;361.
12. Zaccardi F, Webb DR, Yates T, Davies MJ. Pathophysiology of type 1 and type 2 diabetes mellitus: a 90-year perspective. Postgrad Med J. 2016;92(1084):63–9.
13. Kahan S, Manson JE. Nutrition counseling in clinical practice: how clinicians can do better. Jama. 2017;318(12):1101–2.
14. Dyson PA, Twenefour D, Breen C, Duncan A, Elvin E, Goff L, et al. Diabetes UK evidence‐based nutrition guidelines for the prevention and management of diabetes. Diabet Med. 2018;35(5):541–7.
15. Asif M. The prevention and control the type-2 diabetes by changing lifestyle and dietary pattern. J Educ Health Promot. 2014;3(1):1.
16. Miller V, Yusuf S, Chow CK, Dehghan M, Corsi DJ, Lock K, et al. 28. Miller, V.; Yusuf, S.; Chow, C.K.; Dehghan, M.; Corsi, D.J.; Lock, K.; Popkin, B.; Rangarajan, S.; Khatib, R.; Lear, S.A.; et al. Availability, affordability, and consumption of fruits and vegetables in 18 countries across income levels: Findings from. lancet Glob Heal. 2016;4(10):e695–703.
17. Micha R, Shulkin ML, Penalvo JL, Khatibzadeh S, Singh GM, Rao M, et al. Etiologic effects and optimal intakes of foods and nutrients for risk of cardiovascular diseases and diabetes: systematic reviews and meta-analyses from the Nutrition and Chronic Diseases Expert Group (NutriCoDE). PLoS One. 2017;12(4):e0175149.
18. Schwingshackl L, Hoffmann G, Lampousi AM, Knüppel S, Iqbal K, Schwedhelm C, et al. Food groups and risk of type 2 diabetes mellitus: a systematic review and meta-analysis of prospective studies. Eur J Epidemiol. 2017;32:363–75.
19. Bellou V, Belbasis L, Tzoulaki I, Evangelou E. Risk factors for type 2 diabetes mellitus: an exposure-wide umbrella review of meta-analyses. PLoS One. 2018;13(3):e0194127.
20. Putri RT, Wahyuni Y, Jus’ at I. Glycemic load, fiber, magnesium, zinc, physical activity, stress factor and fasting blood glucose level. Darussalam Nutr J. 2021;5(1):1–13.
21. Harrington D, Henson J. Physical activity and exercise in the management of type 2 diabetes: where to start? Pract Diabetes. 2021;38(5):35-40b.
22. Abusaib M, Ahmed M, Nwayyir HA, Alidrisi HA, Al-Abbood M, Al-Bayati A, et al. Iraqi experts consensus on the management of type 2 diabetes/prediabetes in adults. Clin Med Insights Endocrinol Diabetes. 2020;13:1179551420942232.
23. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2011;33(Supplement_1):S62–9.
24. Eyth E, Naik R. Hemoglobin A1c. In: StatPearls [Internet]. StatPearls Publishing; 2023.
25. Kwon YJ, Lee HS, Park JY, Lee JW. Associating intake proportion of carbohydrate, fat, and protein with all-cause mortality in Korean adults. Nutrients. 2020;12(10):3208.
26. Benjamin DJ, Berger JO, Johannesson M, Nosek BA, Wagenmakers EJ, Berk R, et al. Redefine statistical significance. Nat Hum Behav. 2018;2(1):6–10.
27. Al-Mssallem, M., & Al-Arifi S. Dietary Intake and Health Status in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study. Appl Sci. 2022;23(1):116–9.
28. Al-Majidi ZAZ, Lami FH, Hakimi S. Proportion and Potential Risk Factors of Poor Glycemic Control among Patients with Type 2 Diabetes Mellitus: Experience of a Tertiary Center in Baghdad, Iraq, 2020. J Fac Med Baghdad. 2024;66(2):209–15.
29. Al Mansour MA. The prevalence and risk factors of type 2 diabetes mellitus (DMT2) in a semi-urban Saudi population. Int J Environ Res Public Health. 2020;17(1):7.
30. Baral J, Karki KB, Thapa P, Timalsina A, Bhandari R, Bhandari R, et al. Adherence to Dietary Recommendation and Its Associated Factors among People with Type 2 Diabetes: A Cross‐Sectional Study in Nepal. J Diabetes Res. 2022;2022(1):6136059.
31. Kautzky-Willer A, Harreiter J, Pacini G. however, the most prominent risk factor, which is obesity, is more common in women. Generally, large sex-ratio differences across countries are observed. Diversities in biology, culture, lifestyle, environment, and socioeconomic status impact differences . Endocr Rev. 2016;37(3):278–316.
32. Aladhab RA, Alabbood MH. Adherence of patients with diabetes to a lifestyle advice and management plan in Basra, Southern Iraq. Int J Diabetes Metab. 2019;25(3–4):100–5.
33. Hamoodah ZJ, Hasan IR, Mejbel SA, Ali AT. Hyperlipidemia among Patients with type 2 Diabetes Mellitus in Al-Nasiriya City. J Pharm Negat Results. 2022;993–8.
34. Nasir AM, kamil Ouda M, kamil Ouda M. Study Investigate Covid 19 Complications among Type 2 Diabetes Mellitus Patients. 2023;
35. Elenga-Bongo CL, Bouenizabila E, Mayanda RL, Sida GRB, Ongoth FE, Bugova LA, et al. Diabetes Mellitus and Associated Risk Factors in Urban and Rural Congolese Areas. EAS J Med Surg. 2024;6(12):388–97.
36. Sharma N, Sharma SK, Maheshwari VD, Sharma KK, Gupta R. Association of low educational status with microvascular complications in type 2 diabetes: Jaipur diabetes registry-1. Indian J Endocrinol Metab. 2015;19(5):667–72.
37. Mohamed HA, Makhlouf MM, Zainel AA, Osman SO, Selim N. Association of sociodemographic characteristics and lifestyle with type 2 diabetes mellitus and glycemic control: A cross-sectional study. J Community Med Public Heal. 2021;2:2–10.
38. Ali MY, Begum M, Dipu SS. Prevalence of T2 Diabetes Mellitus (DM) Among the Rural People of Selected villages Of Bangladesh. Community Based Med J. 2015;4(1):22–9.
39. Adil Y, Ismail KH. The Effect of Lifestyle Intervention on Glycemic Control in Type 2 Diabetic Patients. Bahrain Med Bull. 2024;46(1).
40. Shiriyedeve S, Dlungwane TP, Tlou B. Factors associated with physical activity in type 2 diabetes mellitus patients at a public clinic in Gaborone, Botswana, in 2017. African J Prim Heal care Fam Med. 2019;11(1):1–7.
41. Parmar MY. Obesity and Type 2 diabetes mellitus. Integr Obes Diabetes. 2018;4(4):1–2.
42. Lee SF, Li CP. Personality as a predictor of HbA1c level in patients with type 2 diabetes mellitus. Medicine (Baltimore). 2021;100(27):e26590.
43. Cederberg H, Stančáková A, Kuusisto J, Laakso M, Smith U. Family history of type 2 diabetes increases the risk of both obesity and its complications: is type 2 diabetes a disease of inappropriate lipid storage? J Intern Med. 2015;277(5):540–51.
44. Ofori EK, Angmorterh SK. Relationship between physical activity, body mass index (BMI) and lipid profile of students in Ghana. Pan Afr Med J. 2019;33(1).
45. Kang N, Liu X, Liao W, Tu R, Sang S, Zhai Z, et al. Health-related quality of life among rural adults with type 2 diabetes mellitus: A cross-sectional study. Eur J Public Health. 2021;31(3):547–53.
46. Kluding PM, Bareiss SK, Hastings M, Marcus RL, Sinacore DR, Mueller MJ. Physical training and activity in people with diabetic peripheral neuropathy: paradigm shift. Phys Ther. 2017;97(1):31–43.
47. Alfaqeeh M, Alfian SD, Abdulah R. Factors associated with diabetes mellitus among adults: Findings from the Indonesian Family Life Survey-5. Endocr Metab Sci. 2024;14:100161.
48. Foster T, Mowatt L, Mullings J. Knowledge, beliefs and practices of patients with diabetic retinopathy at the University Hospital of the West Indies, Jamaica. J Community Health. 2016;41:584–92.
49. Ruhee D, Mahomoodally F. Relationship between family meal frequency and individual dietary intake among diabetic patients. J Diabetes Metab Disord. 2015;14:1–13.
50. Aljahdali AA, Bawazeer NM. Dietary patterns among Saudis with type 2 diabetes mellitus in Riyadh: A cross-sectional study. PLoS One. 2022;17(5):e0267977.
51. Heller T, Kloos C, Keßler D, Müller N, Thierbach R, Wolf G, et al. Use of snacks in insulin‐treated people with diabetes mellitus and association with HbA1c, weight and quality of life: a cross sectional study. Diabet Med. 2015;32(3):353–8.
52. Anguah KOB, Syed-Abdul MM, Hu Q, Jacome-Sosa M, Heimowitz C, Cox V, et al. Changes in food cravings and eating behavior after a dietary carbohydrate restriction intervention trial. Nutrients. 2019;12(1):52.
53. Mirahmadizadeh A, Khorshidsavar H, Seif M, Sharifi MH. Adherence to medication, diet and physical activity and the associated factors amongst patients with type 2 diabetes. Diabetes Ther. 2020;11:479–94.
54. Gay JL, Buchner DM, Schmidt MD. Dose–response association of physical activity with HbA1c: Intensity and bout length. Prev Med (Baltim). 2016;86:58–63.
55. Garcia SP, Cureau FV, de Quadros Iorra F, Bottino LG, Monteiro LERC, Leivas G, et al. Effects of exercise training and physical activity advice on HbA1c in people with type 2 diabetes: A network meta-analysis of randomized controlled trials. Diabetes Res Clin Pract. 2025;112027.
56. Singh B, Koneru YC, Zimmerman H, Kanagala SG, Milne I, Sethi A, et al. A step in the right direction: exploring the effects of aerobic exercise on HbA1c reduction. Egypt J Intern Med. 2023;35(1):58.
57. Yan MR, Parsons A, Whalley GA, Rush EC. Effects of a healthier snack on snacking habits and glycated Hb (HbA1c): a 6-week intervention study. Br J Nutr. 2016;116(12):2169–74.
58. Maguolo A, Mazzuca G, Smart CE, Maffeis C. Postprandial glucose metabolism in children and adolescents with type 1 diabetes mellitus: potential targets for improvement. Eur J Clin Nutr. 2024;78(2):79–86.
59. Vlachos D, Malisova S, Lindberg FA, Karaniki G. Glycemic index (GI) or glycemic load (GL) and dietary interventions for optimizing postprandial hyperglycemia in patients with T2 diabetes: A review. Nutrients. 2020;12(6):1561.
60. Wang YC, Wang C, Shih PW, Tang PL. Analysis of the relationship between lifestyle habits and glycosylated hemoglobin control based on data from a health management plan. Nutr Res Pract. 2020;14(3):218–29.
61. Rorsman P, Ashcroft FM. Pancreatic β-cell electrical activity and insulin secretion: of mice and men. Physiol Rev. 2018;98(1):117–214.
62. Al-Bayati HF, Al-Diwan JK. Dietary pattern assessment and body composition analysis of adult patients with type 2 diabetes mellitus attending diabetes and endocrine center in Mirjan Teaching Hospital, Babil/2021. Med J Babylon. 2022;19(2):250–7.
63. Bag N, Das I, Waliullah M, Manna D, Chatterjee S. Study of Association between BMI and HbA1c Level in Newly-Diagnosed Type-2-Diabetes-Mellitus Patients. SVU-InteStudy Assoc between BMI HbA1c Lev Newly-Diagnosed Type-2-Diabetes-Mellitus Patientsrnational J Med Sci. 2023;6(2):1–9.
64. Lin W. The Association between Body Mass Index and Glycohemoglobin (HbA1c) in the US Population’s Diabetes Status. Int J Environ Res Public Health. 2024;21(5):517.
65. Micha R, Peñalvo JL, Cudhea F, Imamura F, Rehm CD, Mozaffarian D. Association between dietary factors and mortality from heart disease, stroke, and type 2 diabetes in the United States. Jama. 2017;317(9):912–24.
66. Becerra-Tomás N, Blanco Mejía S, Viguiliouk E, Khan T, Kendall CWC, Kahleova H, et al. Mediterranean diet, cardiovascular disease and mortality in diabetes: A systematic review and meta-analysis of prospective cohort studies and randomized clinical trials. Crit Rev Food Sci Nutr. 2020;60(7):1207–27.

