Before prediabetes: targeting insulin resistance with culturally adapted lifestyle interventions in Vietnamese adults over 50: a narrative review
Keywords:
insulin resistance, insulin sensitivity, lifestyle medicine, diabetes prevention, healthy agingAbstract
Objectives: Insulin resistance (IR) is the earliest, most reversible stage of metabolic dysfunction. When caught early, it may be corrected with simple lifestyle changes before it progresses to prediabetes or type 2 diabetes (T2D). In some Asian populations, IR can develop silently for years while body mass index (BMI), fasting glucose, and glycated hemoglobin (HbA1c) remain normal. This narrative review synthesizes evidence that IR can and should be detected early, while plasma glucose is still normal, and that inexpensive tools and culturally adapted nutrition and lifestyle methods should be considered, with insulin resistance as the clinical endpoint rather than diabetes. Scope: The review focuses on Vietnamese and other East Asian adults over 50, who are typically at normal BMI yet metabolically obese. Literature from PubMed and Google Scholar published primarily from 1999 to 2026 was synthesized. Key content: East Asians develop T2D at lower BMI because fat concentrates around the organs at a given body weight. This makes screening based on BMI unreliable for this population. Other tools such as the triglyceride-glucose (TyG) index or HOMA-IR identify IR in lean adults. Resistance training and other physical activity, along with adequate sleep, early time-restricted eating, and attention to micronutrients have supportive evidence for glucose or insulin outcomes. Vietnam's VPAN program improved physical activity and nutrition behaviors but did not measure insulin afterward. Conclusions: Insulin resistance is a practical and economical target for catching metabolic dysfunction at its root. Low-cost surrogates to the clamp, such as HOMA-IR or TyG, can be used to measure it. IR responds to everyday habits, supporting prevention before prediabetes or diabetes develops. Vietnamese intervention data using IR endpoints are absent and represent a priority research gap.
References
1. Lonardo A, Weiskirchen R. Insulin resistance at the crossroads of metabolic inflammation, cardiovascular disease, organ failure and cancer. Biomolecules. 2025;15(12):1745. DOI:10.3390/biom15121745
2. Affuso F, Micillo F, Fazio S. Insulin resistance, a risk factor for Alzheimer’s disease: pathological mechanisms and a new proposal for a preventive therapeutic approach. Biomedicines. 2024;12(8):1888. DOI:10.3390/biomedicines12081888
3. Ding C, Chan Z, Chooi YC, et al. Regulation of glucose metabolism in nondiabetic, metabolically obese normal-weight Asians. Am J Physiol Endocrinol Metab. 2018;314(5):E494-E502. DOI:10.1152/ajpendo.00382.2017
4. Zheng Z, Yin X, Liu J, Zhang Y. Triglyceride-glucose index and its derivatives as emerging biomarkers of insulin resistance for prognostic evaluation of cardiovascular-kidney-metabolic syndrome: mechanisms and clinical applications. Front Pharmacol. 2026;17:1787130. DOI:10.3389/fphar.2026.1787130
5. Huang Z, Gao Y, Liu L, Li M, Yuan Q. Association between the insulin resistance indices and incident type 2 diabetes across different body mass index states: a cohort study and external validation from two East Asian populations. Diabetes Res Clin Pract. 2026;232:113093. DOI:10.1016/j.diabres.2026.113093
6. Toi PL, Wu O, Thavorncharoensap M, et al. Economic evaluation of population-based type 2 diabetes mellitus screening at different healthcare settings in Vietnam. PLoS One. 2021;16(12):e0261231. DOI:10.1371/journal.pone.0261231
7. Nevárez-Sida A, Guerrero-Romero F. The triglycerides and glucose index: a cost-effectiveness analysis compared with the homeostatic model assessment for insulin resistance. Value Health Reg Issues. 2023;37:49-52. DOI:10.1016/j.vhri.2023.05.001
8. Ma RCW, Chan JCN. Type 2 diabetes in East Asians: similarities and differences with populations in Europe and the United States. Ann N Y Acad Sci. 2013;1281(1):64-91. DOI:10.1111/nyas.12098
9. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157-163. DOI:10.1016/S0140-6736(03)15268-3
10. Bộ Y tế. Quyết định số 5481/QĐ-BYT ngày 30/12/2020 về việc ban hành tài liệu chuyên môn “Hướng dẫn chẩn đoán và điều trị đái tháo đường típ 2”. Hà Nội: Bộ Y tế; 2020.
11. Ho NT, Tran MT, Tran CTD, et al. Prevalence of metabolic syndrome among Vietnamese adult employees. Nutr Metab Cardiovasc Dis. 2024;34(2):326-333. DOI:10.1016/j.numecd.2023.10.002
12. Dinh TD, Phuong LN, Van BT, et al. Insulin sensitivity and beta-cell function in healthy Vietnamese adults: insights from HOMA2 analysis. Int J Diabetes Dev Ctries. 2026;46(3):930-940. DOI:10.1007/s13410-025-01471-4
13. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403. DOI:10.1056/NEJMoa012512
14. Rosenfeld RM, Grega ML, Karlsen MC, 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. DOI:10.1177/15598276251325802
15. World Health Organization Regional Office for the Western Pacific. National survey on the risk factors of noncommunicable diseases in Viet Nam, 2021. Manila: WHO Regional Office for the Western Pacific; 2025. Available from: https://iris.who.int/handle/10665/380405. Accessed September 20, 2026.
16. Li J, Li J, Lu Y. Effects of resistance training on insulin sensitivity in the elderly: a meta-analysis of randomized controlled trials. J Exerc Sci Fit. 2021;19(4):241-251. DOI:10.1016/j.jesf.2021.08.002
17. DiPietro L, Gribok A, Stevens MS, Hamm LF, Rumpler W. Three 15-min bouts of moderate post-meal walking significantly improves 24-h glycemic control in older people at risk for impaired glucose tolerance. Diabetes Care. 2013;36(10):3262-3268. DOI:10.2337/dc13-0084
18. Reynolds AN, Mann JI, Williams S, Venn BJ. Advice to walk after meals is more effective for lowering postprandial glycemia in type 2 diabetes mellitus than advice that does not specify timing: a randomized crossover study. Diabetologia. 2016;59(12):2572-2578. DOI:10.1007/s00125-016-4085-2
19. Buffey AJ, Herring MP, Langley CK, Donnelly AE, Carson BP. The acute effects of interrupting prolonged sitting time in adults with standing and light-intensity walking on biomarkers of cardiometabolic health: a systematic review and meta-analysis. Sports Med. 2022;52(8):1765-1787. DOI:10.1007/s40279-022-01649-4
20. Vu LH, Nguyen AN. The nutrition transition in Vietnam: evidence from national household survey data 2012-2020. Crit Public Health. 2026;36(1):2598702. DOI:10.1080/09581596.2025.2598702
21. Reynolds AN, Akerman AP, Mann J. Dietary fibre and whole grains in diabetes management: systematic review and meta-analyses. PLoS Med. 2020;17(3):e1003053. DOI:10.1371/journal.pmed.1003053
22. Hu EA, Pan A, Malik V, Sun Q. White rice consumption and risk of type 2 diabetes: meta-analysis and systematic review. BMJ. 2012;344:e1454. DOI:10.1136/bmj.e1454
23. Sun L, Goh HJ, Govindharajulu P, Leow MK, Henry CJ. Postprandial glucose, insulin and incretin responses differ by test meal macronutrient ingestion sequence (PATTERN study). Clin Nutr. 2020;39(3):950-957. DOI:10.1016/j.clnu.2019.04.001
24. Gower BA, Bergman R, Stefanovski D, et al. Baseline insulin sensitivity affects response to high-amylose maize resistant starch in women: a randomized, controlled trial. Nutr Metab (Lond). 2016;13:2. DOI:10.1186/s12986-016-0062-5
25. Wastyk HC, Fragiadakis GK, Perelman D, et al. Gut-microbiota-targeted diets modulate human immune status. Cell. 2021;184(16):4137-4153.e14. DOI:10.1016/j.cell.2021.06.019
26. An SY, Lee MS, Jeon JY, et al. Beneficial effects of fresh and fermented kimchi in prediabetic individuals. Ann Nutr Metab. 2013;63(1-2):111-119. DOI:10.1159/000353583
27. Song Y, He K, Levitan EB, Manson JE, Liu S. Effects of oral magnesium supplementation on glycemic control in Type 2 diabetes: a meta-analysis of randomized double-blind controlled trials. Diabet Med. 2006;23(10):1050-1056. DOI:10.1111/j.1464-5491.2006.01852.x
28. Zhao JV, Huang X, Zhang J, Chan YH, Tse HF, Blais JE. Overall and sex-specific effect of berberine on glycemic and insulin-related traits: a systematic review and meta-analysis of randomized controlled trials. J Nutr. 2023;153(10):2939-2950. DOI:10.1016/j.tjnut.2023.08.016
29. Xie Z, Sun Y, Ye Y, et al. Randomized controlled trial for time-restricted eating in healthy volunteers without obesity. Nat Commun. 2022;13:1003. DOI:10.1038/s41467-022-28662-5
30. Sutton EF, Beyl R, Early KS, Cefalu WT, Ravussin E, Peterson CM. Early time-restricted feeding improves insulin sensitivity, blood pressure, and oxidative stress even without weight loss in men with prediabetes. Cell Metab. 2018;27(6):1212-1221. DOI:10.1016/j.cmet.2018.04.010
31. Yi X, Yan J, Daut UN, et al. Effects of time-restricted eating without caloric restriction on blood pressure and cardiometabolic profile in non-diabetic adults: a systematic review and meta-analysis of randomized controlled trials. Front Nutr. 2025;12:1631477. DOI:10.3389/fnut.2025.1631477
32. Tran VD, Lee AH, Jancey J, et al. Physical activity and nutrition behaviour outcomes of a cluster-randomized controlled trial for adults with metabolic syndrome in Vietnam (VPAN). Trials. 2017;18:18. DOI:10.1186/s13063-016-1771-9
33. Sun K, Liu J, Ning G. Active smoking and risk of metabolic syndrome: a meta-analysis of prospective studies. PLoS One. 2012;7(10):e47791. DOI:10.1371/journal.pone.0047791
34. Cho SH, Jeong SH, Shin J, Park SH, Jang SI. Short-term smoking increases the risk of insulin resistance. Sci Rep. 2022;12:3550. DOI:10.1038/s41598-022-07626-1
35. Vu LTH, Bui QTT, Tran NTT, et al. Temporal trends in tobacco smoking prevalence during the period 2010-2020 in Vietnam: a repeated cross-sectional study. Int J Public Health. 2024;69:1607104. DOI:10.3389/ijph.2024.1607104
36. Okawa S, Iso H, Yokobori Y, et al. Associations between alcohol consumption and cigarette smoking and insulin secretion and resistance in Vietnamese men without a history of diabetes: a cross-sectional study. J Diabetes Res. 2025;2025:1068375. DOI:10.1155/jdr/1068375
37. Tatsumi Y, Morimoto A, Asayama K, et al. Association between alcohol consumption and incidence of impaired insulin secretion and insulin resistance in Japanese: the Saku study. Diabetes Res Clin Pract. 2018;135:11-17. DOI:10.1016/j.diabres.2017.10.021
38. Kumar S, Gundi M, Atre S, Bich Ngoc L, Nguyen TT, Rammohan A. Alcohol consumption among adults in Vietnam: prevalence, patterns, and its determinants. J Subst Use. 2023;28(1):57-65. DOI:10.1080/14659891.2021.2006343
39. Joseph JJ, Golden SH. Cortisol dysregulation: the bidirectional link between stress, depression, and type 2 diabetes mellitus. Ann N Y Acad Sci. 2017;1391(1):20-34. DOI:10.1111/nyas.13217
40. Armani Kian A, Vahdani B, Noorbala AA, et al. The impact of mindfulness-based stress reduction on emotional wellbeing and glycemic control of patients with type 2 diabetes mellitus. J Diabetes Res. 2018;2018:1986820. DOI:10.1155/2018/1986820
41. Balban MY, Neri E, Kogon MM, et al. Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Rep Med. 2023;4(1):100895. DOI:10.1016/j.xcrm.2022.100895
42. Paul-Labrador M, Polk D, Dwyer JH, et al. Effects of a randomized controlled trial of transcendental meditation on components of the metabolic syndrome in subjects with coronary heart disease. Arch Intern Med. 2006;166(11):1218-1224. DOI:10.1001/archinte.166.11.1218
43. Ni Y, Ma L, Li J. Effects of mindfulness-based intervention on glycemic control and psychological outcomes in people with diabetes: a systematic review and meta-analysis. J Diabetes Investig. 2021;12(6):1092-1103. DOI:10.1111/jdi.13439
44. Ngan HY, Chong YY, Chien WT. Effects of mindfulness- and acceptance-based interventions on diabetes distress and glycemic level in people with type 2 diabetes: systematic review and meta-analysis. Diabet Med. 2021;38(4):e14525. DOI:10.1111/dme.14525
45. Spiegel K, Leproult R, Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet. 1999;354(9188):1435-1439. DOI:10.1016/S0140-6736(99)01376-8
46. Sondrup N, Termannsen AD, Eriksen JN, et al. Effects of sleep manipulation on markers of insulin sensitivity: a systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev. 2022;62:101594. DOI:10.1016/j.smrv.2022.101594
47. Cappuccio FP, D’Elia L, Strazzullo P, Miller MA. Quantity and quality of sleep and incidence of type 2 diabetes: a systematic review and meta-analysis. Diabetes Care. 2010;33(2):414-420. DOI:10.2337/dc09-1124
48. Tuomilehto J, Lindstrom J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344(18):1343-1350. DOI:10.1056/NEJM200105033441801
49. Gong Q, Zhang P, Wang J, et al. Morbidity and mortality after lifestyle intervention for people with impaired glucose tolerance: 30-year results of the Da Qing Diabetes Prevention Outcome Study. Lancet Diabetes Endocrinol. 2019;7(6):452-461. DOI:10.1016/S2213-8587(19)30093-2
Downloads
Publication Date
Issue
Section
License
Copyright (c) 2026 LaVera J.Forbes (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
