Background
This study evaluated the effectiveness of a culturally adapted lifestyle intervention in prediabetes remission to normoglycemia and reducing diabetes progression.
Methods
In two sub-towns of Karachi, 3945 adults were screened with the Indian Diabetes Risk Score; 2165 high-risk participants (aged 30-64 years) were randomized to lifestyle intervention or standard care. The intervention included nine structured sessions on diet, activity, and weight management, plus SMS reminders, cooking demonstrations, and counseling. Participants were followed for two years.
Results
Mean age was 44 years, and 74 % were women; 43 % had prediabetes at baseline. Reversal to normoglycemia occurred in 61 % and 62 % of the intervention group at one and two years versus 39 % and 37 % in standard care (AOR = 2.46, 95 % CI: 1.84-3.29, p < 0.0001). Lower prediabetes remission was observed among overweight (AOR = 0.65), pre-obese (AOR = 0.59), and obese participants (AOR = 0.74). Remission was lower in areas with parks (AOR = 0.77, p = 0.0001). Metabolic syndrome participants in the intervention had higher remission rates (AOR = 4.13). Those with impaired fasting glucose showed markedly greater remission odds (AOR = 8.21).
Conclusion
Culturally tailored lifestyle interventions can significantly induce prediabetes remission, highlighting scalable, low-cost prevention strategies for Pakistan and other LMICs.