[Psychosocial factors and long-term adherence to lifestyle interventions in individuals with type 2 diabetes mellitus].

Type 2 diabetes (T2D) is a complex chronic illness that requires continuous management across multiple domains: nutrition, physical activity, psychological wellbeing and pharmacological therapy. The long-term success of these interventions depends on whether they can be maintained over time. This article discusses systemic, psychosocial and lifestyle factors that influence adherence to dietary lifestyle interventions and their implications for routine clinical care. Current guidelines are patient-focused, emphasizing individualization and adaptation to patients' needs within a multidisciplinary team. Nevertheless, there is a gap between guidelines and real-world implementation. Adherence in T2D is influenced by the interaction of psychosocial, behavioral and structural factors. Psychological factors, such as social support, depression, self-efficacy and coping mechanisms, among others, as well as socioeconomic factors, are all predictors of adherence. We discuss different dietary patterns, such as the mediterranean diet, with regard to adherence and the effects on glycemic control. Across all dietary patterns, adherence consistently declines over time. Less restrictive approaches are associated with higher adherence and lower attrition rates. Consultation times and the integration of behavioral and psychological care into routine management are essential for increasing long-term adherence. Improving these aspects may improve long-term adherence and, consequently, metabolic outcomes.