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Abstract

Background: Integrated lifestyle interventions combining nutritional, physical, and psychological strategies may improve glycemic control in individuals with type 2 diabetes mellitus (T2DM). However, evidence regarding the combined effects of high-fiber functional foods, high-intensity interval training (HIIT), and mindfulness therapy remains limited, particularly in low- and middle-income countries. This study evaluated the effects of a multimodal lifestyle intervention on glycemic responses among individuals with T2DM and non-diabetic adults.

Methods: A quasi-experimental pilot study was conducted among 30 female participants (15 with T2DM and 15 non-diabetic controls) in Medan, Indonesia. Fasting (pre-prandial) and post-prandial blood glucose concentrations were measured repeatedly throughout the intervention. Non-parametric statistical analysis was employed to evaluate the effects of group, time, and their interaction on glucose concentrations.

Results: Significant longitudinal reductions in both pre-prandial and post-prandial glucose concentrations were observed among participants with T2DM (both Friedman p < 0.001). Pairwise comparisons demonstrated significant decreases between all assessment periods (all p = 0.001). There were significant differences in glycemic trajectories between diabetic and non-diabetic participants.

Conclusions: This two-month multimodal lifestyle intervention was associated with a significant reduction in blood glucose levels among individuals with T2DM and those without diabetes. The significant group-by-time interaction suggests greater metabolic improvement during the intervention period for the T2DM group. Larger randomized controlled trials are required to confirm efficacy and establish long-term clinical benefits.

Keywords: Glycemic control, High-intensity interval training, Mindfulness, High fiber snack bar, Type 2 diabetes mellitus, Lifestyle intervention, Indonesia

References

[1] Hossain MJ, Al-Mamun M, Islam MR. Diabetes mellitus, the fastest growing global public health concern: Early detection should be focused. Health Sci Rep 2024;7(3):e2004. https://doi.org/10.1002/hsr2.2004.

[2] International Diabetes Federation [IDF]. IDF diabetes atlas. Brussels: IDF; 2025.

[3] Indonesia, Ministry of Health. Indonesian Health Survey 2023;614.42:69—87 [cited 2026 March]. Available from: https://www.badankebijakan.kemkes.go.id/en/hasil-ski-2023/.

[4] Huang Q, Li Y, Yu M, Lv Z, Lu F, Xu N, et al. Global burden and risk factors of type 2 diabetes mellitus from 1990 to 2021, with forecasts to 2050. Front Endocrinol 2025;16:1538143. https://doi.org/10.3389/fendo.2025.1538143.

[5] Chandrasekaran P, Weiskirchen R. The Role of Obesity in Type 2 Diabetes Mellitus-An Overview. Int J Mol Sci 2024;25(3):1882. https://doi.org/10.3390/ijms25031882.

[6] American Diabetes Association Professional Practice Committee. 8. Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes: Standards of Care in Diabetes-2025. Diabetes Care 2025;48(Suppl 1):S167—80. https://doi.org/10.2337/dc25-S008.

[7] Marume A, Chidoko E, Chirenda J. Dietary interventions and glycaemic control in type 2 diabetes: A systematic review and meta-analysis. J Publ Health Afr 2025;16(1):1325. https://doi.org/10.4102/jphia.v16i1.1325.

[8] Hosseini F, Jayedi A, Khan TA, Shab-Bidar S. Dietary carbohydrate and the risk of type 2 diabetes: an updated systematic review and dose-response meta-analysis of prospective cohort studies. Sci Rep 2022;12(1):2491. https://doi.org/10.1038/s41598-022-06212-9.

[9] Fernandes A, Mateus N, de Freitas V. Polyphenol-Dietary Fiber Conjugates from Fruits and Vegetables: Nature and Biological Fate in a Food and Nutrition Perspective. Foods 2023;12(5):1052. https://doi.org/10.3390/foods12051052.

[10] Zhang H, Tsao R. Dietary polyphenols, oxidative stress and antioxidant and anti-inflammatory effects. Curr Opin Food Sci 2016;8:33—42. https://doi.org/10.1016/j.cofs.2016.02.002.

[11] Nurkolis F, Harbuwono DS, Taslim NA, Soegondo S, Suastika K, Sparringa RA, et al. New insight on dietary strategies to increase insulin sensitivity and reduce diabetes prevalence: an expert perspective and recommendation. Discover Food 2025;5(1):136. https://doi.org/10.1007/s44187-025-00422-6.

[12] Wang Y, Alkhalidy H, Liu D. The Emerging Role of Polyphenols in the Management of Type 2 Diabetes. Molecules 2021;26(3):703. https://doi.org/10.3390/molecules26030703.

[13] Thompson AS, Candussi CJ, Tresserra-Rimbau A, Jennings A, Bondonno NP, Hill C, et al. A healthful plant-based diet is associated with lower type 2 diabetes risk via improved metabolic state and organ function: A prospective cohort study. Diabetes Metab 2024;50(1):101499. https://doi.org/10.1016/j.diabet.2023.101499.

[14] Silva J, Anghinoni I, Gomes MB. Plant-Based Food for the Prevention of Type 2 Diabetes: Scoping Review. Nutrients 2024;16(11):1671. https://doi.org/10.3390/nu16111671.

[15] Li SC, Liu YH, Liu JF, Chang WH, Chen CM, Chen CY. Almond consumption improved glycemic control and lipid profiles in patients with type 2 diabetes mellitus. Metabolism 2011;60(4):474—9. https://doi.org/10.1016/j.metabol.2010.04.009.

[16] Gulati S, Misra A, Tiwari R, Sharma M, Pandey RM, Upadhyay AD, et al. Premeal almond load decreases postprandial glycaemia, adiposity and reversed prediabetes to normoglycemia: A randomized controlled trial. Clin Nutr ESPEN 2023;54:12—22. https://doi.org/10.1016/j.clnesp.2022.12.028.

[17] Mori AM, Considine RV, Mattes RD. Acute and second-meal effects of almond form in impaired glucose tolerant adults: a randomized crossover trial. Nutr Metab 2011;8(1):6. https://doi.org/10.1186/1743-7075-8-6.

[18] Nurdjanah S, Nurdin SU, Astuti S, Manik VE. Chemical Components, Antioxidant Activity, and Glycemic Response Values of Purple Sweet Potato Products. Int J Food Sci 2022;2022:7708172. https://doi.org/10.1155/2022/7708172.

[19] Mi W, Hu Z, Zhao S, Wang W, Lian W, Lu P, et al. Purple sweet potato anthocyanins normalize the blood glucose concentration and restore the gut microbiota in mice with type 2 diabetes mellitus. Heliyon 2024;10(11):e31784. https://doi.org/10.1016/j.heliyon.2024.e31784.

[20] Gulati S, Misra A, Tiwari R, Sharma M, Pandey RM, Upadhyay AD, et al. Beneficial effects of premeal almond load on glucose profile on oral glucose tolerance and continuous glucose monitoring: randomized crossover trials in Asian Indians with prediabetes. Eur J Clin Nutr 2023;77(5):586—95. https://doi.org/10.1038/s41430-023-01263-1.

[21] Wang H, Zhou Q, Shen LH, Zhang JL. The mechanism of purple sweet potato anthocyanin extract to reduce the digestion rate and improve the starch digestion characteristics based on dough system. Int J Biol Macromol 2024;277(Pt 4):134551. https://doi.org/10.1016/j.ijbiomac.2024.134551.

[22] Yu Z, Nan F, Wang LY, Jiang H, Chen W, Jiang Y. Effects of high-protein diet on glycemic control, insulin resistance and blood pressure in type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials. Clin Nutr 2020;39(6):1724—34. https://doi.org/10.1016/j.clnu.2019.08.008.

[23] Ekberg NR, Catrina SB, Spegel P. A protein-rich meal provides beneficial glycemic and hormonal responses as compared to meals enriched in carbohydrate, fat or fiber, in individuals with or without type-2 diabetes. Front Nutr 2024;11:1395745. https://doi.org/10.3389/fnut.2024.1395745.

[24] Rosell MLA, Quizhpe J, Ayuso P, Penalver R, Nieto G. Proximate Composition, Health Benefits, and Food Applications in Bakery Products of Purple-Fleshed Sweet Potato (Ipomoea batatas L.) and Its By-Products: A Comprehensive Review. Antioxidants 2024;13(8):954. https://doi.org/10.3390/antiox13080954.

[25] Robinson J, Nitschke E, Tovar A, Mattar L, Gottesman K, Hamlett P, et al. Nutrition and Physical Activity Interventions Provided by Nutrition and Exercise Practitioners for the General Population: An Evidence-Based Practice Guideline From the Academy of Nutrition and Dietetics and American Council on Exercise. J Acad Nutr Diet 2023;123(8):1215—1237.e5. https://doi.org/10.1016/j.jand.2023.04.004.

[26] Koehler K, Drenowatz C. Integrated Role of Nutrition and Physical Activity for Lifelong Health. Nutrients 2019;11(7):1437. https://doi.org/10.3390/nu11071437.

[27] Saenz C, Salinas M, Rothman RL, White RO. Personalized Lifestyle Modifications for Improved Metabolic Health: The Role of Cultural Sensitivity and Health Communication in Type 2 Diabetes Management. J Am Nutr Assoc 2025;44(3):198—211. https://doi.org/10.1080/27697061.2024.2413368.

[28] Suprapti B, Izzah Z, Anjani AG, Andarsari MR, Nilamsari WP, Nugroho CW. Prevalence of medication adherence and glycemic control among patients with type 2 diabetes and influencing factors: A cross-sectional study. Glob Epidemiol 2023;5:100113. https://doi.org/10.1016/j.gloepi.2023.100113.

[29] Perkumpulan Endokrinologi Indonesia [PERKENI]. National endocrinology forum XIII [cited 2026 March]. Perkumpulan Endokrinologi Indonesia, Jakarta. Available from: https://pbperkeni.or.id/.

[30] Arisanti CIS, Wirasuta I, Musfiroh I, Ikram EHK, Muchtaridi M. Mechanism of Anti-Diabetic Activity from Sweet Potato (Ipomoea batatas): A Systematic Review. Foods 2023;12(14):2810. https://doi.org/10.3390/foods12142810.

[31] Gotama G, Sadek NF, Tedjakusuma F. Almond flour and its potential in diabetes management: a short review. IOP Conf Ser Earth Environ Sci 2024;1352:012091. https://doi.org/10.1088/1755-1315/1352/1/012091.

[32] Setyanto HY. The Effect of Sorghum (Sorghum Bicolor (L.)) Snack Bar Formulation on Organoleptic Properties. Jurnal Pendidikan dan Keluarga 2021;13(2):65—72. https://doi.org/10.24036/jpk/vol13-iss02/916.

[33] Indonesia, Ministry of Industry, Center for Standardization and Industrial Quality. Indonesian national standards food and beverage testing methods. Jakarta: Ministry of Industry; 1992.

[34] Hidayatullah MF, Ellyas IS. Menjaga kebugaran dengan HIIT (High Intensity Interval Training). 1st ed. Solo: Cakra Wijaya 2022.

[35] Putri UN, Bintari DR, Munisa M. Penerapan teknik mindfulness-based streess reducion. 1st ed. Medan: PT. Pustaka Pratama Edukasia 2025.

[36] Rosenfeld RM, Grega ML, Karlsen MC, Abu Dabrh AM, Aurora RN, Bonnet JP, et al. Lifestyle Interventions for Treatment and Remission of Type 2 Diabetes and Prediabetes in Adults: A Clinical Practice Guideline From the American College of Lifestyle Medicine. Am J Lifestyle Med 2025;19(2 Suppl):10S—131S. https://doi.org/10.1177/15598276251325488.

[37] Espinola OP, Tobias DK, Manson JE. The Role of Lifestyle Interventions for the Prevention and Treatment of Type 2 Diabetes: A Narrative Review. Am J Lifestyle Med 2025;20(4):15598276251372427. https://doi.org/10.1177/15598276251372427.

[38] Sagastume D, Siero I, Mertens E, Cottam J, Colizzi C, Penalvo JL. The effectiveness of lifestyle interventions on type 2 diabetes and gestational diabetes incidence and cardiometabolic outcomes: A systematic review and meta-analysis of evidence from low- and middle-income countries. EClinicalMedicine 2022;53:101650. https://doi.org/10.1016/j.eclinm.2022.101650.

[39] McGee SL, Hargreaves M. Exercise adaptations: molecular mechanisms and potential targets for therapeutic benefit. Nat Rev Endocrinol 2020;16(9):495—505. https://doi.org/10.1038/s41574-020-0377-1.

[40] Stocks B, Zierath JR. Post-translational Modifications: The Signals at the Intersection of Exercise, Glucose Uptake, and Insulin Sensitivity. Endocr Rev 2022;43(4):654—77. https://doi.org/10.1210/endrev/bnab038.

[41] Long YC, Zierath JR. AMP-activated protein kinase signaling in metabolic regulation. J Clin Investig 2006;116(7):1776—83. https://doi.org/10.1172/jci29044.

[42] Rahmi Y, Kurniawati AD, Widyanto RM, Ariestiningsih AD, Al Farahi AZ, Ruchaina AN, et al. The sensory, physical and nutritional quality profiles of purple sweet potato and soy-based snack bars for pregnant women. J Public Health Res 2021;10(2):2241. https://doi.org/10.4081/jphr.2021.2241.

[43] Cassidy YM, McSorley EM, Allsopp PJ. Effect of soluble dietary fibre on postprandial blood glucose response and its potential as a functional food ingredient. J Funct Foods 2018;46:423—39. https://doi.org/10.1016/j.jff.2018.05.019.

[44] Prasad KN, Bondy SC. Dietary fibers and their fermented short-chain fatty acids in prevention of human diseases. Bioact Carbohydr Dietary Fibre 2019;17:100170. https://doi.org/10.1016/j.bcdf.2018.09.001.

[45] Maqsood S, Basher NS, Arshad MT, Ikram A, Kalman DS, Hossain MS, et al. Anthocyanins From Sweet Potatoes (Ipomoea batatas): Bioavailability, Mechanisms of Action, and Therapeutic Potential in Diabetes and Metabolic Disorders. Food Sci Nutr 2025;13(9):e70895. https://doi.org/10.1002/fsn3.70895.

[46] Noreen S, Niazi MK, Shehzadi S, Ikram A, Arshad MT, Gnedeka KT. Extend the emphasis to encompass sweet potatoes health advantages, industrial applications, and nutritional qualities. CYTA - Journal of Food 2024;22(1):2390994. https://doi.org/10.1080/19476337.2024.2390994.

[47] Park G, Johnson K, Miller K, Kadyan S, Singar S, Patoine C, et al. Almond snacking modulates gut microbiome and metabolome in association with improved cardiometabolic and inflammatory markers. npj Sci Food 2025;9(1):35. https://doi.org/10.1038/s41538-025-00403-0.

[48] Trumbo PR, Ard J, Bellisle F, Drewnowski A, Gilbert JA, Kleinman R, et al. Perspective: Current Scientific Evidence and Research Strategies in the Role of Almonds in Cardiometabolic Health. Curr Dev Nutr 2025;9(1):104516. https://doi.org/10.1016/j.cdnut.2024.104516.

[49] Viderman D, Rakhmanov Y, Aubakirova M, Kalikanov S, Fredericson M. The Impact of High-Intensity Interval Training on Cardiometabolic, Neurologic, Oncologic, and Pain-Related Outcomes: A Comprehensive Review of Systematic Reviews. J Clin Med 2025;14(23):8328. https://doi.org/10.3390/jcm14238328.

[50] Han C, Lu P, Yan SZ. Effects of high-intensity interval training on mitochondrial supercomplex assembly and biogenesis, mitophagy, and the AMP-activated protein kinase pathway in the soleus muscle of aged female rats. Exp Gerontol 2022;158:111648. https://doi.org/10.1016/j.exger.2021.111648.

[51] Abe T, Kitaoka Y, Kikuchi DM, Takeda K, Numata O, Takemasa T. High-intensity interval training-induced metabolic adaptation coupled with an increase in Hif-1α and glycolytic protein expression. J Appl Physiol 2015;119(11):1297—302. https://doi.org/10.1152/japplphysiol.00499.2015.

[52] Norton L, Shannon C, Gastaldelli A, DeFronzo RA. Insulin: The master regulator of glucose metabolism. Metabolism 2022;129:155142. https://doi.org/10.1016/j.metabol.2022.155142.

[53] He Y, Yang X, He X, Wang G, Li C, Yuan P, et al. Mechanisms and therapeutics of insulin signaling transduction genes in diabetic cardiomyopathy: a comprehensive updated review. Front Endocrinol 2025;16:1589695. https://doi.org/10.3389/fendo.2025.1589695.

[54] Islam H, Gillen JB. Skeletal muscle mechanisms contributing to improved glycemic control following intense interval exercise and training. Sports Med Health Sci 2023;5(1):20—8. https://doi.org/10.1016/j.smhs.2023.01.002.

[55] Al-Rawaf HA, Gabr SA, Iqbal A, Alghadir AH. High-Intensity Interval Training Improves Glycemic Control, Cellular Apoptosis, and Oxidative Stress of Type 2 Diabetic Patients. Medicina (Kaunas) 2023;59(7):1320. https://doi.org/10.3390/medicina59071320.

[56] Dahlgaard J, Jørgensen MM, van der Velden AM, Sumbundu A, Gregersen N, Olsen RK, et al. Chapter 22 - Mindfulness, Health, and Longevity. In: Rattan SIS, Kyriazis M, editors. The Science of Hormesis in Health and Longevity. London: Academic Press; 2019.

[57] Merabet N, Lucassen PJ, Crielaard L, Stronks K, Quax R, Sloot PMA, et al. How exposure to chronic stress contributes to the development of type 2 diabetes: A complexity science approach. Front Neuroendocrinol 2022;65:100972. https://doi.org/10.1016/j.yfrne.2021.100972.

[58] Hackett RA, Steptoe A. Type 2 diabetes mellitus and psychological stress - a modifiable risk factor. Nat Rev Endocrinol 2017;13(9):547—60. https://doi.org/10.1038/nrendo.2017.64.

[59] Sparacio A, Ijzerman H, Ropovik I, Giorgini F, Spiessens C, Uchino BN, et al. Self-administered mindfulness interventions reduce stress in a large, randomized controlled multi-site study. Nat Hum Behav 2024;8(9):1716—25. https://doi.org/10.1038/s41562-024-01907-7.

[60] Galluzzi S, Solorzano CS, Marizzoni M, Gatti E, Gualco C, Lanfredi M, et al. The Effects of Mindfulness-Based Interventions on Physiological Markers of Stress in Older Adults: A Systematic Review and Synthesis. Mindfulness 2026;17(1):1—25. https://doi.org/10.1007/s12671-025-02718-1.

[61] Gonzalez-Rodriguez M, Pazos-Couselo M, Garcia-Lopez JM, Rodriguez-Segade S, Rodriguez-Garcia J, Tunez-Bastida C, et al. Postprandial glycemic response in a non-diabetic adult population: the effect of nutrients is different between men and women. Nutr Metab 2019;16:46. https://doi.org/10.1186/s12986-019-0368-1.

[62] Tungsirikoon N, Howteerakul N, Suwannapong N, Rawdaree P. An Audit of Diabetes-Dependent Quality of Life and Glycemic Control Among Type 2 Diabetes Patients in a Tertiary Hospital in Bangkok: A Hospital-based Cross-sectional Study. J Health Res 2023;37(6):450—7. https://doi.org/10.56808/2586-940X.1053.

[63] Sangkawichai P, Kamchang P, Paisawaeng K, Wongpimkham P, Saita S, Vittaporn S, et al. Factors Associated with Health Literacy and Self-care Behaviors among Patients with Type 2 Diabetes: A Mixed Method Study in Ko Kha District, Lampang Province, Northern Thailand. J Health Res 2024;38(4):301—10. https://doi.org/10.56808/2586-940X.1086.

[64] Watcharanat P. Effects of a Mobile Application-based Self-management Programme on Health Knowledge, Health Behaviours, and Glycaemic Control in Patients With Type 2 Diabetes Mellitus. J Health Res 2025;39(5):380—91. https://doi.org/10.56808/2586-940X.1153.

[65] Magkos F, Reeds DN, Mittendorfer B. Evolution of the diagnostic value of "the sugar of the blood": hitting the sweet spot to identify alterations in glucose dynamics. Physiol Rev 2023;103(1):7—30. https://doi.org/10.1152/physrev.00015.2022.

[66] Choi JH, Cho YJ, Kim HJ, Ko SH, Chon S, Kang JH, et al. Effect of Carbohydrate-Restricted Diets and Intermittent Fasting on Obesity, Type 2 Diabetes Mellitus, and Hypertension Management: Consensus Statement of the Korean Society for the Study of Obesity, Korean Diabetes Association, and Korean Society of Hypertension. Diabetes Metab J 2022;46(3):355—76. https://doi.org/10.4093/dmj.2022.0038.

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