Geographical Living Settings, Lifestyle Behaviors, and the Prevalence of Prediabetes or Diabetes: A Cross-Sectional Community-Based Study in Northern Ibaraki, Japan.

Diabetes mellitus is a growing public health concern worldwide, shaped by both individual and environmental factors. This cross-sectional study looked at how geographical living settings relate to the prevalence of prediabetes or diabetes among 1880 participants in northern Ibaraki, Japan, of whom 1255 (66.8%) had prediabetes or diabetes. Participants were grouped as urban, suburban, or rural based on population density. Glycemic status was measured directly through HbA1c during community health examinations, and lifestyle information was gathered through standardized self-reported questionnaires. Prediabetes and diabetes were combined into a single category for the analysis. After adjusting for age, sex, BMI, and selected lifestyle behaviors, suburban participants had lower odds of prediabetes or diabetes than urban participants (OR = 0.69, 95% CI 0.54-0.89, p = 0.005), while the rural setting showed no significant association. Both daily and occasional alcohol consumption were linked to lower odds compared with rarely drinking, and lifestyle behaviors differed by sex and geographical living setting. Overall, these findings suggest that where people live may be connected to their odds of having prediabetes or diabetes, and they point to the value of considering suburban areas as their own category rather than relying on a simple urban-rural division. As a cross-sectional study, the results show associations rather than cause and effect, and would need to be confirmed in prospective studies. These findings may also help guide future public health efforts in Japan and similar regional settings, where suburban settings may offer a mix of features that support better glycemic status and deserve closer attention.