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Lifestyle medicine for type 2 diabetes: practice-based evidence for long-term efficacy of a multicomponent lifestyle intervention (Reverse Diabetes2 Now)
  1. Gerda K Pot1,2,
  2. Marieke CE Battjes-Fries1,
  3. Olga N Patijn1,
  4. Nynke van der Zijl3,
  5. Hanno Pijl4 and
  6. Peter Voshol1
  1. 1Louis Bolk Instituut, Department of Nutrition and Health, Bunnik, The Netherlands
  2. 2King's College London Division of Diabetes and Nutritional Sciences, London, UK
  3. 3General Practitioner, Amsterdam, The Netherlands
  4. 4Leids Universitair Medisch Centrum, Leiden, Zuid-Holland, The Netherlands
  1. Correspondence to Dr Gerda K Pot, Louis Bolk Instituut, Bunnik 3981 AJ, Netherlands; g.pot{at}


Introduction A wealth of evidence supports short-term efficacy of lifestyle interventions in type 2 diabetes (T2D). However, little is known about long-term effects of lifestyle interventions in real-life settings.

Methods This observational, single-arm study evaluated long-term impact of ‘Voeding Leeft: Reverse-Diabetes2-Now’, a 6-month multicomponent lifestyle programme, on glycaemic control and glucose-lowering medication (GLmed) use, other T2D parameters and quality of life in 438 T2D participants at 6, 12, 18 and 24 months using paired sample t-tests, χ2 and generalised linear models.

Results At 24 months, 234 participants provided information on GLmed and HbA1c (‘responders’). 67% of the responders used less GLmed, and 28% ceased all GLmed. Notably, 71% of insulin users at baseline (n=47 of 66 insulin users) were off insulin at 24 months. Mean HbA1c levels were similar at 24 months compared with baseline (55.6±12.8 vs. 56.3±10.5 mmol/mol, p=0.43), but more responders had HbA1c levels ≤53 mmol/mol at 24 months (53% vs 45% at baseline). Furthermore, triglyceride levels (−0.34±1.02 mmol/L, p=0.004), body weight (−7.0±6.8 kg, p<0.001), waist circumference (−7.9±8.2 cm, p<0.001), body mass index (−2.4±2.3 kg/m2, p<0.001) and total cholesterol/high-density lipoprotein (HDL) ratio (−0.22±1.24, p=0.044) were lower, while HDL (+0.17 ± 0.53 mmol/L, p<0.001) and low-density lipoprotein-cholesterol levels (+0.18 ± 1.06 mmol/L, p=0.040) were slightly higher. No differences were observed in fasting glucose or total cholesterol levels. Quality of life and self-reported health significantly improved.

Conclusion This study indicates robust, durable real-life benefits of this lifestyle group programme after up to 24 months of follow-up, particularly in terms of medication use, body weight and quality of life in T2D patients.

  • nutritional treatment
  • diabetes mellitus

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  • GKP and MCB-F contributed equally.

  • Contributors GKP analysed the data, drafted and revised the manuscript; MB-F designed the study, collected, collated and analysed the data and revised the manuscript; ONP collected data and revised the manuscript; NvdZ was responsible for the medical coordination of the intervention and revised the manuscript. HP is chief medical advisor of Voeding Leeft, and provided scientific input to design of the study and manuscript; PV co-designed the lifestyle intervention and the study, revised the manuscript and is responsible for the overall content of the manuscript (guarantor).

  • Funding This work was supported by Ekhaga (application number 2017-55) and by VGZ Health Insurance via the foundation Voeding Leeft.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Medical Ethical Reviewing Committee of Wageningen University (NL) reviewed the study protocol and is of the opinion that it does not fall within the remit of the Dutch ‘Medical Research Involving Human Subjects Act’ (17 January 2019).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. Data may be obtained from a third party (Foundation Voeding Leeft) and are not publicly available.

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