Differential Associations of Healthy Lifestyle Latent Classes with Glycemic Transitions in Prediabetes: An Observational Study Based on CHARLS

Introduction: Current clinical guidelines recommend comprehensive management of multiple healthy lifestyles as fundamental to prediabetes care; however, the evidence base regarding the status and clustering of these risk factors remains insufficient. We identified distinct latent classes of healthy lifestyle in individuals with prediabetes and examined their impact on glycemic progression. Methods: This study included 2529 baseline prediabetic participants from the China Health and Retirement Longitudinal Study (CHARLS). We performed latent class analysis (LCA) to stratify participants according to healthy lifestyle factors: physical activity, smoking, alcohol consumption, sleep duration, body mass index (BMI), and blood pressure. Multiple imputation was used for missing covariate data. Multinomial logistic regression was used to examine associations with glycemic transition. Results: Three healthy lifestyle classes were identified: Class 1 (27.6%, the smoking and drinking group), Class 2 (28.2%, the high-BMI group), and Class 3 (44.3%, the healthy lifestyle group). Compared with Class 3, Class 1 (OR, 0.736; 95% CI, 0.554 to 0.978) and Class 2 (OR, 0.628; 95% CI, 0.489 to 0.806) had significantly decreased odds of returning to normoglycemia. Conversely, Class 2 (OR, 2.167; 95% CI, 1.626 to 2.887) had higher odds of progressing to diabetes than Class 3. Conclusions: Prediabetic individuals fall into three distinct healthy lifestyle latent classes. The distinct associations between the three lifestyle latent classes and glycemic progression to diabetes and regression to normoglycemia support the potential value of lifestyle-based risk stratification in prediabetes management, pending validation in prospective cohorts.