Structural Equation Modeling to Untangle Pathways of Risk Factors Associated with Incident Type 2 Diabetes

The development of type 2 diabetes is multifactorial. Unraveling the complex pathways of modifiable risk factors related to type 2 diabetes will help prioritise prevention targets. In this study, we analysed a conceptual model, which described the pathways of multiple modifiable risk factors in relation to incident type 2 diabetes. 

Our results showed that among all modifiable risk factors included, waist circumference had the biggest direct effect on type 2 diabetes, followed by HDL-cholesterol. Less TV watching and more physical activity were found to play an important role in improving clinical markers that were directly associated with type 2 diabetes. Education had the biggest positive effects on all lifestyle behaviors except for unhealthy sleep duration.

For primary prevention, this simultaneous quantification of multiple risk factors and their intersecting pathways puts scattered evidence together and enables the identification of key upstream prevention targets for type 2 diabetes. 

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