Retrospective Analysis of the Efficacy of Integrated Lifestyle Modifications in Managing Prediabetes in the Indian Population

<b>Background:</b> Prediabetes is a growing health concern in India, with a prevalence of 15.3%. This retrospective study was aimed at assessing the effectiveness of an integrated intensive lifestyle intervention (ILI) in Indian patients with prediabetes while exploring sex- and body mass index (BMI)-based differences. <b>Methods:</b> This retrospective study analyzed data from 427 patients with prediabetes (HbA1c: 5.7%-6.4% not on insulin or oral hypoglycemic agents and aged 18-75 years) who underwent a 1-year online ILI program at the Freedom from Diabetes Clinic, India, between 2020 and 2023. The intervention consisted of a personalized plant-based diet, physical activity, psychological support, and medical management. Anthropometric and biochemical data were extracted from the clinical database, and logistic regression was used to identify factors associated with prediabetes remission. <b>Results:</b> At the end of the study, 47.1% of patients achieved prediabetes remission. Significant weight loss and improvements were observed in HbA1c, BMI, fasting blood glucose, fasting insulin, insulin resistance, lipid profile, and blood pressure (<i>p</i> < 0.05). Notably, 34% of patients lost > 10% of their body weight. Females achieved greater reductions in weight and BMI than males (<i>p</i> < 0.001). The BMI stratified analysis revealed higher remission rates in the obesity group (BMI ≥ 25 kg/m²) (49.9%) than in the nonobesity group (BMI 18-24.9 kg/m²) (37.0%) (<i>p</i> = 0.028). The obesity group showed greater improvements in glycemic parameters and insulin resistance than the nonobesity group (<i>p</i> < 0.05). Logistic regression identified age ≤ 50 years (OR: 2.15, 95% CI: 1.42-3.27), endline HOMA-IR < 2.5 (OR: 1.60, 95% CI: 1.01-2.45), and > 10% weight loss (OR: 3.72, 95% CI: 2.34-5.90) as significant factors associated with prediabetes remission. <b>Conclusions:</b> Prediabetes remission was achieved in almost half of the patients, highlighting the effectiveness of a tailored multidisciplinary approach for managing prediabetes in the Indian population. The study showed significant weight loss, improved glycemic control, and better lipid profiles and emphasized the need for personalized strategies for prediabetes management considering factors such as sex and BMI. <b>Trial Registration:</b> Clinical Trials Registry of India identifier: CTRI/2024/03/064596.