Editorial: (Un)healthy lifestyles, Aging, and Type 2 Diabetes

Pedro Alexandre Duarte-Mendes^1,2*Fernanda M. Silva^3,4*Ana Maria Teixeira^5*

• ¹Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal
• ²Sport Physical Activity and Health Research & Innovation Center (SPRINT), Castelo Branco, Portugal
• ³University of Coimbra, Faculty of Sport Sciences and Physical Education, Coimbra, Portugal, Coimbra, Portugal
• ⁴School of Education and Communication, University of Algarve, Faro, Portugal
• ⁵University of Coimbra, Faculty of Sport Sciences and Physical Education, Coimbra, Portugal

Recent esƟmates from the IDF Diabetes Atlas indicate that diabetes affects 589 million adults worldwide in 2024, with type 2 diabetes (T2D) accounƟng for more than 90% of cases (InternaƟonal Diabetes FederaƟon, 2025). This number is projected to reach 853 million by 2050. Age is an important risk factor for T2D, with esƟmates indicaƟng that one in four adults with the disease (158 million) are over 65 years old. Poor lifestyle factors, such as lack of exercise, sedentary behavior, and poor diet, are important underlying factors in the development of obesity and insulin resistance, leading to T2D and cardiovascular disease (Liu et al., 2024; Bowden Davies et al., 2018). On the other hand, effecƟve intervenƟons, such as regular exercise and a healthy diet, have been recommended to improve glucose metabolism in both diabeƟc and non-diabeƟc individuals (Silva et al., 2024; Syeda et al., 2023; Kim & Kwon, 2024). In addiƟon to engaging in regular exercise, studies have demonstrated the benefits of interrupƟng siƫng Ɵme with regular bouts of movement (Syeda et al., 2023). Given the high prevalence of T2D, mainly in the middle-aged and elderly populaƟon, it is important to invesƟgate the impact of (un)healthy lifestyles on metabolic markers and to create a set of strategies to prevent or control T2D and its related complicaƟons. This Research Topic, Editorial: (Un)healthy lifestyles, Aging, and Type 2 Diabetes, addresses these quesƟons through nine complementary contribuƟons. The opening arƟcle by Wang et al. focuses on elderly health management services, one of China's basic public health projects, along with the psychological care program for older adults in Shenzhen, Guangdong Province. This is highly relevant considering that China has one of the largest elderly populaƟons in the world, with more than 264 million people aged 60 or older. Using the Long-gang District's efforts to integrate physical and mental health services as an example, this review highlights the challenges of elderly health work and the potenƟal for combining mental and physical health in medical care. The authors emphasize the importance of prioriƟzing elderly needs, reinforcing community health services, establishing integrated teams, enhancing public awareness and health literacy, strengthening collaboraƟon across system levels, and improving coordinaƟon between healthcare and social support services to build a stronger public health system for the elderly and advance the broader goal of Healthy China. The study by Zhang, Qu, and Kang aimed to assess the global, regional, and naƟonal burden of T2D aƩributable to low physical acƟvity from 1990 to 2021 and predict its global burden by 2050. UƟlizing data from the Global Burden of Disease 2021 data, authors esƟmated that T2D aƩributed to low physical acƟvity caused approximately 149,214 deaths and 5.5 million disability-adjusted life-years (DALYs), with an increase since 1990. Both age-standardized mortality and disability-adjusted life years increased, parƟcularly among women. The highest incidence occurred in the elderly (70-74 and 95+ years old). High sociodemographic index (SDI) regions report the highest mortality rates, with rapid growth in areas with high-middle SDI. ProjecƟons from 2022 to 2050 indicate conƟnued growth in deaths and DALYs. The study by Jiang et al. used bibliometric analysis to comprehensively and systemaƟcally organize the literature related to the modulaƟon of gut microbiome for the treatment of T2D and to provide guidance for future studies. The authors found that current research focuses mainly on the effects of diet, exercise, and pharmacological modificaƟon of the gut microbiome to improve T2D and explores the mechanisms involved in this process. They also stated that future research will delve more deeply into the specific mechanisms that regulate gut microbiome to ameliorate T2D and will extend to T2D-related diseases and symptoms. In this sense, it will be essenƟal to develop new experimental techniques and assays to advance this field. CogniƟve funcƟon and its associaƟon with T2D are the focus of two studies. The cohort study by Wei and He invesƟgated the potenƟal mediaƟng role of cogniƟve impairment on the relaƟonship between T2D and all-cause mortality among 1,891 elderly individuals from the NaƟonal Health and NutriƟon ExaminaƟon Survey (NHANES) database. The findings revealed that older adults with T2D had a significantly higher likelihood of experiencing cogniƟve impairment and that T2D was associated with an increased all-cause mortality. Moreover, results suggested a mediaƟng role of cogniƟve impairment in the associaƟon between T2D and all-cause mortality, with a mediaƟon effect of 16.2%. The study by Srikantha et al. examined the relaƟonship between T2D and cogniƟve funcƟon among older adults in India and China. Cross-secƟonal analysis showed no associaƟon between T2D and cogniƟon in fully adjusted models for both countries. However, the area of residence and level of educaƟon modified these relaƟonships. In India, T2D was posiƟvely associated with cogniƟon in rural areas and among individuals with none or early childhood educaƟon, with no relaƟonship among those with at least an upper secondary educaƟon. In China, an inverse associaƟon was observed only among those with less than lower secondary educaƟon, with no associaƟon among the remainder of the sample. According to the authors, these results differ from those observed in high-income countries, which may indicate ongoing effects of the epidemiological and nutriƟonal transiƟons observed in India and China. The study by Bai et al. invesƟgated the prevalence of physical, psychological, and cogniƟve comorbidiƟes among older adults with diabetes in rural areas and examined the impact of lifestyle factors on health outcomes across different co-morbidity condiƟons. Authors found a relaƟvely high prevalence (86.08%) of physical, psychological and cogniƟve co-morbidity among parƟcipants. Factors such as regular physical acƟvity, adequate sleep, healthy diet and acƟve social parƟcipaƟon were correlated with a lower prevalence of co-morbidity. The authors reinforce the importance of mulƟfactorial lifestyle intervenƟons in diabeƟc individuals to reduce the risk and burden of co-occurring condiƟons. The qualitaƟve study by Skoradal et al. aimed to explore the moƟvaƟonal factors influencing physical acƟvity engagement among individuals with T2D in the Faroe Islands. Eight individuals, aged between 43 and 69 years old, parƟcipated in two semi-structured interviews. ThemaƟc analysis revealed four main themes, including fear of consequences, starƟng exercise, hoping to keep on, and being social. According to the authors, these findings highlight the complexity of moƟvaƟon, ranging from controlled forms (i.e., fear of complicaƟons) to more autonomous moƟvaƟons (i.e., enjoyment, social connecƟon). This study thus provides insights into the moƟvaƟonal factors influencing physical acƟvity among individuals with T2D. An interesƟng meta-analysis of randomized controlled trial conducted by Sun, Li and Xue examined the effects of Tai Chi on glycemic control in T2D. Meta-analyƟc results showed that Tai Chi significantly reduces fasƟng blood glucose, HbA1c, triglycerides, LDL-cholesterol, and some inflammatory markers such as hs-CRP, IL-6, and TNF-α. Subgroup analysis indicated opƟmal fasƟng glucose reducƟon with the standardized 24-form Tai Chi rouƟne; intervenƟons of 12 weeks or more; frequency greater than 5 sessions per week, and daily exercise duraƟon equal to or greater than 60 minutes. These findings suggest that Tai Chi promotes benefits for T2D management. Another bibliometric and visualizaƟon analysis by Jin et al. used CiteSpace to invesƟgate the hotspots and development trends in exercise intervenƟon mechanisms for T2D. According to the results, research on this topic has focused on changes in biological effects and molecular mechanisms (e.g., improvement in pancreaƟc beta cell funcƟon, exerkines, and epigeneƟc mechanisms). Emerging research focuses on the heterogeneity of the response to exercise, circadian rhythm regulaƟon, neurotrophic factors, transcripƟon factors, and mitochondrial funcƟon. According to the authors, future research should explore the interacƟons between different mechanisms and elucidate the appropriate modes, dosages, and intensiƟes of exercise for precise intervenƟon in T2D. CollecƟvely, these studies highlight the importance of an integrated, mulƟfactorial approach to the prevenƟon and/or management of T2D, especially in the elderly populaƟon. Studies reinforce the important role of healthy lifestyle factors, including regular exercise and a balanced diet, in effecƟvely managing the disease and reducing the risk of associated comorbidiƟes. Furthermore, studies have focused on the associaƟon between T2D and cogniƟve funcƟon, which is oŌen compromised in older adults. One study suggests that cogniƟve dysfuncƟon could play a mediaƟng role in the relaƟonship between T2D and mortality in this populaƟon. Given the projected increase of the disease, it is necessary to develop more coordinated public health strategies focused on the elderly.