Lifestyle guidance based on the Dietary Guidelines for the Brazilian Population and the Physical Activity Guidelines for the Brazilian Population, including recommendations regarding healthy eating, physical activity, sleep, stress management, alcohol consumption, and smoking behavior. Guidance is delivered during scheduled follow-up visits without structured behavioral counseling, goal-setting procedures, self-monitoring support, ongoing support contacts, or group education sessions.

A structured lifestyle intervention delivered entirely through telehealth over 36 months. The program includes 17 individual counseling sessions, 15 structured support contacts, and 6 group education sessions designed to improve diet quality, physical activity, sleep quality, stress management, alcohol consumption, smoking behavior, and self-care practices through behavior change strategies tailored to participants' readiness to change.

to compare the proportion of individuals with controlled blood glucose (<126mg/dl) obtained through laboratory exams/tests without the use of hypoglycemic medication

to compare the proportion of individuals with HbA1c (<6.4%) obtained through laboratory exams/tests without the use of hypoglycemic medication

to compare mean weight (kg) between groups

to compare the proportion of individuals who are physically active (>150 minutes of moderate to vigorous physical activity) and inactive (<150 minutes of moderate to vigorous physical activity) between groups

to compare mean time in minutes of practice of moderate/vigorous physical activity over a week between groups

to compare the proportion of individuals engaging in moderate or vigorous physical activity and sedentary behavior

to compare the proportion of individuals who engage in 150 minutes or more of physical activity per week

to compare the proportion of sedentary individuals

to compare mean score of the Diet Quality Index Revised (DQI-R) between groups Minimum: 0 Maximum: 100 When higher the score, better the quality of diet

to compare the mean caloric intake (kcal) from ultra-processed foods obtained through two 24-hour Dietary Recall applied within a period of fifteen days

to analyze the quality of life based on delta value of the eight domains (Functional capacity, Physical aspects, Pain, General health status, Vitality, Social aspects, Emotional aspects and Mental health) When higher the score, better the quality of life related to the assessed domain

To compare the cost of interventions. To estimate healthcare system costs, we will consider only direct medical costs, which include screening costs, intervention costs, and costs of healthcare service utilization. To estimate social costs, we will consider not only direct medical costs but also non-medical direct costs, such as transportation, food, and accommodation expenses reported by participants when seeking medical assistance, as well as time spent traveling to and participating in group sessions. Additionally, we will include indirect costs, calculated based on the assumption that each necessary hospitalization results in a loss of 9 hours of paid work and each outpatient visit results in a loss of half a day (4.5 hours) of paid work

To analyze the correlation between years of study and the incidence of type 2 diabetes

T2DM incidence across Brazillian five geographic regions (North, Northeast, Central-West (Midwest), Southeast, South)

Association between T2DM incidence and individual Low or high income (accessed by ABEP - Critério Brasil 2022 questionnaire. A Brazilian validated questionnaire to evaluate Household income)

correlation between neighborhood value (as assessed using the Gini index) and incidence of type 2 diabetes (DM2)

to compare mean BMI (kg/m2) between groups

to compare the proportion of individuals in use of hypoglycemic medication

to compare mean delta weight (kg) between groups (delta = final mean weight - baseline mean weight)

To compare the mean delta glycemia (mg/dL) between groups:

Delta = Mean glycemia at the final measurement - Mean glycemia at baseline

This approach evaluates the difference in blood glucose changes across the groups over the study period, reflecting the intervention's impact on glycemic control.

To compare the mean delta HbA1c (%) between groups:

Delta = Mean HbA1c at the final measurement - Mean HbA1c at baseline

This approach evaluates the difference in blood glucose changes across the groups over the study period, reflecting the intervention's impact on glycemic control.

To compare the mean delta Insulin (μU/mL) between groups:

Delta = Mean Insulin at the final measurement - Mean Insulin at baseline

This approach evaluates the difference in Insulin changes across the groups over the study period, reflecting the intervention's impact on glycemic control.

To compare the mean delta HOMA-IR between groups:

Delta = Mean HOMA-IR at the final measurement - Mean HOMA-IR at baseline

HOMA-IR (Homeostatic Model Assessment of Insulin Resistance) is calculated using the following formula:

HOMA-IR = [Fasting insulin (μU/mL) × Fasting glucose (mg/dL)] / 405

This approach evaluates the difference in insulin resistance changes across the groups over the study period, reflecting the intervention's impact on metabolic control.

To compare the mean delta HOMA-Beta between groups:

Delta = Mean HOMA-Beta at the final measurement - Mean HOMA-Beta at baseline

HOMA-Beta (Homeostatic Model Assessment of Beta-Cell Function) is calculated using the following formula:

HOMA-Beta = [360 × Fasting insulin (μU/mL)] / [Fasting glucose (mg/dL) - 63]

This approach evaluates the difference in beta-cell function changes across the groups over the study period, reflecting the intervention's impact on pancreatic function.

To compare the mean delta PSQI-BR scores between groups:

Delta = Mean PSQI-BR score at the final measurement - Mean PSQI-BR score at baseline

The PSQI-BR (Pittsburgh Sleep Quality Index - Brazilian version) is a validated instrument used to assess sleep quality. It generates a total score based on seven components:

Subjective sleep quality Sleep latency Sleep duration Habitual sleep efficiency Sleep disturbances Use of sleeping medications Daytime dysfunction Each component is scored from 0 to 3, and the total PSQI score ranges from 0 to 21, with higher scores indicating worse sleep quality.

This approach evaluates the difference in sleep quality changes across the groups over the study period, reflecting the intervention's impact on sleep outcomes.

To compare the mean delta PPS-10 scores between groups:

Delta = Mean PPS-10 score at the final measurement - Mean PPS-10 score at baseline

The PPS-10 (Perceived Stress Scale - 10-item Brazilian version) is a validated instrument used to assess perceived stress over the last month. It consists of 10 questions scored on a 5-point Likert scale (0 = never, 1 = almost never, 2 = sometimes, 3 = fairly often, 4 = very often).

The total score ranges from 0 to 40, with higher scores indicating greater perceived stress.

This approach evaluates the difference in perceived stress levels across the groups over the study period, reflecting the intervention's impact on stress outcomes.

To compare the mean alcohol consumption (g/day) between groups.

Alcohol consumption will be assessed using a specific Alcohol Frequency Questionnaire, which records the type, frequency, and quantity of alcoholic beverages consumed. The total alcohol intake will be calculated in grams per day using the formula:

Grams of alcohol/day = (Volume consumed [mL] × Alcohol content [%] × 0.8) / Days

Where:

Volume consumed is the reported quantity of alcoholic beverage. Alcohol content [%] is the average alcohol percentage for each beverage type. 0.8 is the density of pure ethanol.

This approach evaluates the difference in perceived stress levels across the groups over the study period, reflecting the intervention's impact on stress outcomes.

To compare the proportion of smokers between groups at the end of the study:

Smoking status will be assessed by self-report as either:

Current smokers Former smokers Never smoked

The proportion of smokers will be calculated as:

Proportion of smokers (%) = (Number of smokers / Total participants in the group) × 100

The comparison will focus on the proportion of current smokers in each group at the study's conclusion to evaluate the intervention's impact on smoking prevalence.

To compare the mean number of cigarettes smoked per day between groups at the end of the study:

Smoking behavior will be assessed by participants self-report the average number of cigarettes smoked per day.

The mean number of cigarettes smoked per day for each group will be calculated as:

Mean number of cigarettes/day = (Total number of cigarettes smoked by participants in the group) / (Number of participants who are current smokers)

This comparison will evaluate the intervention's impact on the average smoking intensity among individuals who continue to smoke.

To compare the mean scores of the eight SF-36 quality of life domains between groups at the end of the study:

Quality of life will be assessed using the SF-36 Health Survey, which evaluates eight domains:

Physical functioning Role limitations due to physical health Role limitations due to emotional problems Energy/fatigue Emotional well-being Social functioning Pain General health

Each domain generates a score ranging from 0 to 100, where higher scores indicate better quality of life.

The mean scores for each domain will be calculated as:

Mean domain score = (Sum of scores for all participants in the group) / (Number of participants in the group)

This comparison will assess differences in quality of life between groups at the study's conclusion, reflecting the intervention's impact across various health dimensions.