Integrating neural substrates, diabetes self-management, and behavior change for tailored lifestyle interventions in type-2 diabetes: A neurobehavioral perspective

Understanding the neural mechanisms that underlie behavior change is critical for improving lifestyle management in type 2 diabetes. Individuals with type 2 diabetes face unique challenges in adopting and maintaining healthy behaviors, which can be influenced by alterations in brain function and plasticity, potentially leading to cognitive impairment. Diabetes self-management education and support (DSMES) programs aim to enhance lifestyle changes and promote better health outcomes while reducing cognitive decline. However, complex neural disruptions in critical regions for cognitive processes like the prefrontal cortex and parietal lobe present significant challenges. Given the likely role of neural mechanisms in behavioral choices, understanding how type 2 diabetes affects these neural substrates is crucial for developing effective interventions. Despite considerable research efforts aimed at testing lifestyle interventions, a critical gap remains in understanding the cognitive and behavioral components of successful diabetes self-management, the neural substrates of those components, and the impact of diabetes on those neural substrates. Bridging this gap necessitates a comprehensive examination integrating neural processes, DSMES strategies, and behavior change models. Thus, this perspective review highlights the urgent need to address the knowledge gaps surrounding the neural correlates of diabetes selfmanagement and the integration of behavioral models into intervention frameworks. We propose a hypothesis-generating question and present preliminary findings comparing neural plasticity, executive functions, and lifestyle behavior among individuals with type 2 diabetes, pre-diabetes, and healthy controls. By elucidating the neural substrates underpinning diabetes and exploring their implications for DSMES and readiness to change, we can pave the way for more effective, personalized approaches to diabetes care.