Behavioral and Lifestyle Determinants of Poor Glycemic Control Among Adults with Type 2 Diabetes in Lesotho: Implications for Public Health in Low-Resource Settings

Type 2 diabetes mellitus (T2DM) is a growing public health challenge worldwide, disproportionately affecting populations in low- and middle-income countries (LMICs). Poor glycemic control contributes significantly to the global burden of non-communicable diseases (NCDs), increasing morbidity, mortality, and healthcare costs. Understanding behavioral and lifestyle determinants is critical for designing effective public health strategies, particularly in resource-limited settings such as Lesotho. A cross-sectional population-based study was conducted among 184 adults with T2DM attending the out-patient department of Maluti Adventist Hospital, Lesotho. Data was collected using a structured questionnaire and analyzed descriptively with SPSS 26 Variables assessed included sociodemographic, dietary practices, physical activity, behavioral risk factors and self-care knowledge. Participants were predominantly aged 45-69 years (65.2%), with an equal sex distribution. Hypertension was the most prevalent comorbidity (65.2%). Risk factor exposure was widespread, 100% consumed fewer than five daily servings of fruits/vegetables, 95.1% reported insufficient physical activity, and 88.0% had elevated blood pressure. Overall, 86.4% had three or more NCD risk factors. Knowledge levels were intermediate, with 33.2% scoring poor, 52.7% moderate, and only 14.1% good. Glycemic control was suboptimal, with 40.8% uncontrolled. This study highlights the urgent public health need to address lifestyle and behavioral determinants of poor glycemic control in Lesotho. Tailored interventions focusing on dietary education, physical activity promotion, and routine monitoring are essential to reduce NCD risks and improve outcomes. The findings have broader implications for achieving Sustainable Development Goal 3.4 on reducing premature NCD mortality in LMICs. Strengthening culturally sensitive health promotion, community-based interventions, and integrated chronic disease care models could significantly advance diabetes prevention and control in low-resource settings.