{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:58:39Z","timestamp":1792789119407,"version":"4.5.0"},"reference-count":32,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Oradea","id":[{"id":"https:\/\/ror.org\/00wzhv093","id-type":"ROR","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/00wzhv093","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Lifestyle modification is central to type 2 diabetes mellitus (T2DM) management, but adherence is difficult to assess in routine care. We developed a pragmatic Lifestyle Compliance Index (LCI) from routinely collected behavioral variables and examined its cross-sectional associations with cardio-renal-metabolic measures. Objectives: To describe the LCI, compare outcomes across adherence categories, evaluate adjusted associations, and quantify incremental discrimination for prevalent metabolic and renal abnormalities. Methods: Adults with T2DM attending a specialized outpatient diabetes clinic in Romania were assessed using a standardized clinical questionnaire and routine laboratory data. The LCI combined seven binary behaviors and graded physical activity (0\u20132 points; theoretical range 0\u20139). Group comparisons, unadjusted bivariate and adjusted multivariable regressions, false discovery rate correction, and stratified five-fold cross-validated logistic models were used. Results: Among 232 participants, 231 had a complete LCI; low, moderate, and high adherence included 84 (36.4%), 94 (40.7%), and 53 (22.9%) participants, respectively. Higher LCI scores were associated with lower adiposity, HbA1c, TyG index, triglycerides, creatinine, and SCORE2-Diabetes risk and with higher eGFR. In models adjusted for age, sex, and diabetes duration, each LCI point was associated with lower odds of obesity (aOR 0.749), elevated TyG index (0.757), albuminuria (0.716), reduced eGFR (0.802), and HbA1c \u2265 7% (0.833). Adding LCI improved cross-validated discrimination most for albuminuria (AUC 0.482 to 0.642), obesity (0.489 to 0.619), and elevated TyG index (0.524 to 0.646). The baseline albuminuria AUC was below chance, and the extended AUC remained modest. Conclusions: In this cross-sectional sample, higher self-reported lifestyle adherence was associated with a more favorable cardio-renal-metabolic profile. The LCI should be considered exploratory until validated against objective measures and tested in larger prospective populations.<\/jats:p>","DOI":"10.3390\/diagnostics16183068","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T14:12:09Z","timestamp":1789999929000},"page":"3068","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Lifestyle Adherence and Metabolic Control in Adults with Type 2 Diabetes: Development of a Lifestyle Compliance Index"],"prefix":"10.3390","volume":"16","author":[{"given":"Bianca-L\u0103crimioara","family":"Petca","sequence":"first","affiliation":[{"name":"Doctoral School of Biological and Biomedical Sciences, University of Oradea, 1 University Street, 410087 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"}]},{"given":"Paula-Alexandra","family":"Popovici","sequence":"additional","affiliation":[{"name":"Doctoral School of Biological and Biomedical Sciences, University of Oradea, 1 University Street, 410087 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"}]},{"given":"Andreea Diana","family":"Igna","sequence":"additional","affiliation":[{"name":"Doctoral School of Biological and Biomedical Sciences, University of Oradea, 1 University Street, 410087 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8981-1958","authenticated-orcid":false,"given":"Timea Claudia","family":"Ghitea","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Faculty of Medicine and Pharmacy, University of Oradea, 1 University Street, 410087 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"given":"Mihaela Simona","family":"Popoviciu","sequence":"additional","affiliation":[{"name":"Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"funding-acquisition","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Shen, N., Jin, S., Yue, Z., Song, Z., and Wu, M. (2026). Global burden and future trends of type 2 diabetes mellitus-associated chronic kidney disease: Analysis of the Global Burden of Disease Study 2021. Int. J. Clin. Pharm.","DOI":"10.1007\/s11096-026-02201-4"},{"key":"ref_2","unstructured":"International Diabetes Federation (2025). IDF Diabetes Atlas, Google Scholar. [11th ed.]. Available online: https:\/\/diabetesatlas.org\/resources\/idf-diabetes-atlas-2025\/."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"731","DOI":"10.2337\/dci19-0014","article-title":"Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report","volume":"42","author":"Evert","year":"2019","journal-title":"Diabetes Care"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1016\/j.jhep.2024.04.031","article-title":"EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD)","volume":"81","author":"Tacke","year":"2024","journal-title":"J. Hepatol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"P\u00e9rez, E.A., Gonz\u00e1lez, M.P., Mart\u00ednez-Espinosa, R.M., Vila, M.D.M., and Reig Garc\u00eda-Galbis, M. (2019). Practical Guidance for Interventions in Adults with Metabolic Syndrome: Diet and Exercise vs. Changes in Body Composition. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16183481"},{"key":"ref_6","unstructured":"American Diabetes Association Professional Practice Committee (2026). Standards of Care in Diabetes\u20142026. Diabetes Care, 49, S1\u2013S5."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Sandri, E., Capoferri, M., Luciani, G., and Piredda, M. (2025). The Link Between Physical Activity, Nutrition, and Health: A Cross-Sectional Study with Multivariate Analysis in a Young and Predominantly Female Spanish Sample. Nutrients, 17.","DOI":"10.3390\/nu17091486"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Kim, D., Kim, D., Kim, H., and Kim, J. (2026). Association of a Comprehensive Healthy Lifestyle Score with Risk of All-Cause, Cancer, and Cardiovascular Mortality: Evidence from an 18-Year Cohort Study. Nutrients, 18.","DOI":"10.3390\/nu18050856"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Kim, D., Kang, M., Kim, D., Park, J., and Kim, J. (2026). The Association Between Composite Healthy Lifestyle Score and Type 2 Diabetes Risk in the Korean Population: The Korean Genome and Epidemiology Study. Nutrients, 18.","DOI":"10.3390\/nu18020273"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"16330","DOI":"10.1038\/s41598-024-66772-w","article-title":"On the use of the healthy lifestyle index to investigate specific disease outcomes","volume":"14","author":"Viallon","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1007\/s44192-025-00266-7","article-title":"Correlation between a healthy lifestyle index, quality of life, and depression in Iranian individuals with cardiovascular disease","volume":"5","author":"Akbari","year":"2025","journal-title":"Discov. Ment. Health"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1186\/s12933-024-02347-3","article-title":"Lifestyle factors and their relative contributions to longitudinal progression of cardio-renal-metabolic multimorbidity: A prospective cohort study","volume":"23","author":"Zhang","year":"2024","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Mih\u0103il\u0103, D., Domnariu, H.-P., Moga, D.-F.-C., and Domnariu, C.-D. (2026). Metabolic Reprogramming Driven by Modifiable Lifestyle Factors in Metabolic Syndrome and Alcohol-Related Liver Disease: A Narrative Review. Metabolites, 16.","DOI":"10.3390\/metabo16040224"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Tamini, S., Bondesan, A., Caroli, D., Marazzi, N., and Sartorio, A. (2025). The Ability of the Triglyceride-Glucose (TyG) Index and Modified TyG Indexes to Predict the Presence of Metabolic-Associated Fatty Liver Disease and Metabolic Syndrome in a Pediatric Population with Obesity. J. Clin. Med., 14.","DOI":"10.3390\/jcm14072341"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"22799036251395268","DOI":"10.1177\/22799036251395268","article-title":"Factors affecting lifestyle modification among adults with type II diabetes mellitus attending care at Mbale Regional Referral Hospital in Mbale City, Eastern Uganda: A Mixed Methods Study","volume":"14","author":"Gidudu","year":"2025","journal-title":"J. Public Health Res."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Abose, S., Dassie, G.A., Megerso, A., and Charkos, T.G. (2024). Adherence to recommended diet among patients with diabetes mellitus type 2 on follow-up at Adama Hospital Medical College, Ethiopia. Front. Med., 11.","DOI":"10.3389\/fmed.2024.1484071"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.jacl.2025.08.022","article-title":"Lifestyle management approaches for obesity","volume":"20","author":"Landry","year":"2026","journal-title":"J. Clin. Lipidol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"163","DOI":"10.5455\/medarh.2019.73.163-168","article-title":"The Triglyceride\/HDL Ratio and Triglyceride Glucose Index as Predictors of Glycemic Control in Patients with Diabetes Mellitus Type 2","volume":"73","author":"Babic","year":"2019","journal-title":"Med. Arch."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"27","DOI":"10.4274\/BMB.galenos.2022.2021-09-095","article-title":"Relationship between HbA1c level and triglyceride\/HDL cholesterol ratio and triglyceride glucose index in diabetes patients","volume":"7","author":"Gedikli","year":"2022","journal-title":"Bagcilar Med. Bull."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1186\/s12944-024-02277-9","article-title":"The association between triglyceride-glucose index and its combination with systemic inflammation indicators and all-cause and cardiovascular mortality in the general US population: NHANES 1999-2018","volume":"23","author":"Chen","year":"2024","journal-title":"Lipids Health Dis."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Demir, A.K., \u015eahin, \u015e., \u00c7\u0131t\u0131l, R., Demir, O., and \u00d6zmen, Z.C. (2025). Utility of TyG-Based Indices for Predicting Insulin Resistance in Turkish Adults: Insights from the TEKHAP Study. J. Clin. Med., 14.","DOI":"10.3390\/jcm14248965"},{"key":"ref_22","first-page":"e81550","article-title":"Triglyceride-Glucose Index and Atherogenic Index as Alternative Biomarkers for Glycemic Control in Type 2 Diabetes Mellitus","volume":"17","author":"Gajjar","year":"2025","journal-title":"Cureus"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Cao, C., Wang, T.B., Hu, H., Han, Y., Zhang, X., and Wang, Y. (2024). Relationship between glycated hemoglobin levels and three-month outcomes in acute ischemic stroke patients with or without diabetes: A prospective Korean cohort study. BMC Neurol., 24.","DOI":"10.1186\/s12883-024-03581-8"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"555","DOI":"10.2147\/DMSO.S508365","article-title":"Association Between Body Mass Index and Glycemic Control in Type 2 Diabetes Mellitus: A Cross-Sectional Study","volume":"18","author":"Deng","year":"2025","journal-title":"Diabetes Metab. Syndr. Obes."},{"key":"ref_25","first-page":"e88571","article-title":"Genetic and Behavioral Predictors of Long-Term Weight Loss Maintenance: A Systematic Review of Evidence From Observational and Genetic Studies","volume":"17","author":"Ozojide","year":"2025","journal-title":"Cureus"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1002\/nop2.638","article-title":"Prevalence of obesity and association between body mass index and different aspects of lifestyle in medical sciences students: A cross-sectional study","volume":"8","author":"Aslani","year":"2021","journal-title":"Nurs. Open"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Du, Y.Z., Zhang, C.T., Zeng, D.M., Li, Y., and Liu, Y.F. (2025). Association between urinary albumin-to-creatinine ratio within normal range and kidney stones in U.S. adults: A cross-sectional observational study. Front. Endocrinol., 16.","DOI":"10.3389\/fendo.2025.1526694"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"316","DOI":"10.4082\/kjfm.2015.36.6.316","article-title":"Differences in Factors Associated with Albuminuria according to Gender and Comorbidities of Hypertension and Diabetes","volume":"36","author":"Jang","year":"2015","journal-title":"Korean J. Fam. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3075","DOI":"10.2337\/dci22-0027","article-title":"Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO)","volume":"45","author":"Khunti","year":"2022","journal-title":"Diabetes Care"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1177\/13872877261432600","article-title":"Associations between self-reported change in lifestyle behaviors and brain health: Findings from the Healthy Brain Initiative","volume":"111","author":"Tolea","year":"2026","journal-title":"J. Alzheimers Dis."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Hung, C.-C., Zhen, Y.-Y., Niu, S.-W., Lin, K.-D., Lin, H.Y.-H., Lee, J.-J., Chang, J.-M., and Kuo, I.-C. (2022). Predictive Value of HbA1c and Metabolic Syndrome for Renal Outcome in Non-Diabetic CKD Stage 1\u20134 Patients. Biomedicines, 10.","DOI":"10.3390\/biomedicines10081858"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"104807","DOI":"10.1016\/j.numecd.2026.104807","article-title":"The role of assessing frailty in cardiometabolic risk management","volume":"36","author":"Joshi","year":"2026","journal-title":"Nutr. Metab. Cardiovasc. Dis."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/18\/3068\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T14:43:41Z","timestamp":1790001821000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/18\/3068"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,21]]},"references-count":32,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["diagnostics16183068"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16183068","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,21]]}}}