Post-Diagnosis Trajectories in Treatment, Adiposity, Glycemic Control, and Dietary Behavior Among Adults with Type 2 Diabetes in Mexico

Type 2 diabetes mellitus (T2DM) is a major public health challenge in low- and middle-income countries, yet little is known about how treatment, behavior, adiposity, and glycemic control evolve after diagnosis. Using repeated cross-sectional data from ENSANUT (2006, 2012, 2018), we analyzed 9,277 Mexican adults aged 20 and older with prior physician-diagnosed T2DM, examining post-diagnosis trajectories in treatment use, household expenditure on non-recommended foods, body mass index (BMI), overweight, obesity, glycosylated hemoglobin (HbA1c), and fasting blood glucose, using pooled models with fixed effects for age-at-diagnosis-by-sex and municipality, and testing heterogeneity by sex and socioeconomic status (SES). Treatment uptake rose and remained elevated with time since diagnosis, reaching 24.4 percentage points at 12 years (p0.01), while household expenditure on non-recommended foods showed little sustained change. BMI declined gradually, remaining 2.54 kg/m lower at 12 years (p0.01); obesity was 16.9 percentage points lower (p0.01); overweight followed a less consistent trend. Glycemic control did not improve: HbA1c remained elevated at longer durations, reaching 1.01 percentage points at 12 years (p0.01), with fasting glucose showing a similar pattern. Diagnosis is associated with rapid increases in clinical engagement, but glycemic control remains persistently poor despite rising treatment use, suggesting that improving outcomes may require integrated care combining pharmacological management with sustained behavioral support, closer metabolic monitoring, and attention to the social conditions shaping long-term self-management.