Post-diagnosis trajectories in treatment, adiposity, glycaemic control, and dietary behaviour among adults with type 2 diabetes in Mexico
File(s)
Published version (in press)
Author(s)
García-Díaz, Rocio
Marcos, Miguel Ángel Talamas
Serván-Mori, Edson
Miraldo, Marisa
del Castillo, Ernesto
Type
Journal Article
Abstract
Background
Type 2 diabetes mellitus (T2DM) is a major public health challenge, particularly in low- and middle-income countries. Although much is known about its determinants and costs, less is known about how treatment, behaviour, adiposity, and glycaemic control evolve after diagnosis. We examined post-diagnosis trajectories in these domains among adults living with T2DM in Mexico.
Methods
We used repeated cross-sectional data from ENSANUT 2006, 2012, and 2018 and analysed 9277 adults aged 20 years and older with a prior physician diagnosis of T2DM (mean age 55.7 years, SD 13.1). The main exposure was time since diagnosis. Outcomes included current treatment use, household expenditure on non-recommended foods, body mass index (BMI), overweight, obesity, glycosylated hemoglobin (HbA1c %), and fasting blood glucose in a biomarker subsample. We estimated adjusted post-diagnosis trajectories using pooled models with covariates and fixed effects for age-at-diagnosis-by-sex and municipality, and examined heterogeneity by sex and socioeconomic status (SES).
Results
Treatment uptake was higher at longer durations since diagnosis and remained elevated over time, reaching +24.4 percentage points at 12 or more years (p<0.01) relative to the year-of-diagnosis reference. Household expenditure on non-recommended foods showed little evidence of sustained change. BMI declined gradually, remaining at —2.54 kg/m2 lower in the 12 or more years category (p<0.01), while obesity was 16.9 percentage points lower in the same category (p<0.01); changes in overweight were less regular. Glycaemic control did not improve over time: HbA1c remained elevated at longer durations since diagnosis, reaching +1.01 percentage points in the 12 or more years category (p<0.01), and fasting blood glucose showed a similar qualitative pattern. These trajectories exhibited social disparities. At 12 or more years post-diagnosis, the treatment-use increase relative to the year-of-diagnosis reference was 4 percentage points larger among men than women and 5 percentage points larger among higher-SES than lower-SES respondents.
Conclusions
In this setting, diagnosis is associated with rapid increases in clinical engagement, but post-diagnosis trajectories show persistent poor glycaemic control despite increased treatment use. Post-diagnosis care that expands treatment without sustained glycaemic control may be insufficient. Improving outcomes after diagnosis may require integrated care models that combine pharmacological management with sustained behavioural support, closer metabolic monitoring, and greater attention to the social and household conditions that shape long-term self-management.
Type 2 diabetes mellitus (T2DM) is a major public health challenge, particularly in low- and middle-income countries. Although much is known about its determinants and costs, less is known about how treatment, behaviour, adiposity, and glycaemic control evolve after diagnosis. We examined post-diagnosis trajectories in these domains among adults living with T2DM in Mexico.
Methods
We used repeated cross-sectional data from ENSANUT 2006, 2012, and 2018 and analysed 9277 adults aged 20 years and older with a prior physician diagnosis of T2DM (mean age 55.7 years, SD 13.1). The main exposure was time since diagnosis. Outcomes included current treatment use, household expenditure on non-recommended foods, body mass index (BMI), overweight, obesity, glycosylated hemoglobin (HbA1c %), and fasting blood glucose in a biomarker subsample. We estimated adjusted post-diagnosis trajectories using pooled models with covariates and fixed effects for age-at-diagnosis-by-sex and municipality, and examined heterogeneity by sex and socioeconomic status (SES).
Results
Treatment uptake was higher at longer durations since diagnosis and remained elevated over time, reaching +24.4 percentage points at 12 or more years (p<0.01) relative to the year-of-diagnosis reference. Household expenditure on non-recommended foods showed little evidence of sustained change. BMI declined gradually, remaining at —2.54 kg/m2 lower in the 12 or more years category (p<0.01), while obesity was 16.9 percentage points lower in the same category (p<0.01); changes in overweight were less regular. Glycaemic control did not improve over time: HbA1c remained elevated at longer durations since diagnosis, reaching +1.01 percentage points in the 12 or more years category (p<0.01), and fasting blood glucose showed a similar qualitative pattern. These trajectories exhibited social disparities. At 12 or more years post-diagnosis, the treatment-use increase relative to the year-of-diagnosis reference was 4 percentage points larger among men than women and 5 percentage points larger among higher-SES than lower-SES respondents.
Conclusions
In this setting, diagnosis is associated with rapid increases in clinical engagement, but post-diagnosis trajectories show persistent poor glycaemic control despite increased treatment use. Post-diagnosis care that expands treatment without sustained glycaemic control may be insufficient. Improving outcomes after diagnosis may require integrated care models that combine pharmacological management with sustained behavioural support, closer metabolic monitoring, and greater attention to the social and household conditions that shape long-term self-management.
Date Issued
2026-09-24
Date Acceptance
2026-08-26
Citation
BMC Public Health, 2026
ISSN
1471-2458
Publisher
BMC
Journal / Book Title
BMC Public Health
Copyright Statement
© The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Identifier
10.1186/s12889-026-29250-8
Subjects
Type 2 diabetes mellitus
Post-diagnosis trajectories
Glycaemic control
Obesity
Treatment uptake
Mexico
Publication Status
Published online
Date Publish Online
2026-09-24