Carmen A.W. Dietvorst1,2, Kirsten A.C. Berk1
1Department of Internal Medicine, division of Dietetics, Erasmus MC, Rotterdam
2Department of Internal Medicine, Sint Franciscus Hospital, Rotterdam
Background: Dietary interventions support type 2 diabetes (T2D) management, but financial constraints often hinder individuals with lower socioeconomic status (SES) to adopt healthy diets. ‘Food Prescription Programs’ (FPPs), offering financial support for healthy food, have shown promising results in the USA but remain unstudied in Europe. This study determines the difference in the 3-month effectiveness of a FPP on glycaemic regulation compared to usual care, in adults with T2D and overweight.
Methods: In this 3-month randomised controlled pilot study, adults with T2D, BMI>25 and low income (< 25,000 euros/year) from Rotterdam South were included. Both groups received Mediterranean diet and three coaching sessions with a dietician for three months. The intervention group also received the FPP, consisting of free weekly plant-based food boxes and three health workshops. The primary outcome was the difference in HbA1c after three months.
Results: Thirty-five participants (mean age 57.3 years; 74% female) were included, of whom 17 received the FPP. In the intervention group, fruit intake (78±53 to 156±107 g, p=0.034) and vegetable intake (145(87-225) to 177(135-273) g, p=0.002) increased, alongside improvements in weight (92.0±24.8 to 90.8±24.5 kg, p=0.016), BMI (31.0(27.6-37.5) to 29.7(26.4-38.7) kg/m2, p=0.015) and fasting glucose (8.9±1.9 to 8.3±1.6 mmol/l, p=0.041). Between-group differences showed greater improvements in vegetable intake (177(135-273) vs 140(100-156) g, p=0.040), quality of life (physical limitations 85.9±31.6 vs 40.4±38.9, p=0.001; emotional limitations 91.7±25.8 vs 68.8±41.2, p=0.045) and treatment satisfaction (10.9±6.2 vs 4.6±7.6, p=0.021) in the intervention group. No differences in HbA1c, medication use or cardiovascular risk factors were found.
Conclusion: This first European FPP pilot shows the program is feasible and may improve diet, weight, quality of life, and treatment satisfaction in people with T2D and low SES. These results are an important stimulus for larger RCTs on the effect and implementation of FPPs to increase health equity among people with T2D.