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Adapting the Dutch Reverse Diabetes2 Now program for Belgian primary care: a quasi-experimental study of
Charlotte Juton1, Johan Van der Heyden2, Stefanie Vandevijvere3
1Department of Health Information, Food systems and Nutrition, Sciensano, Rue Juliette Wytsman 14, Bruxelles, 1050, Belgique. charlotte.juton@sciensano.be.
Introduction:
The prevalence of diabetes in Belgium has steadily increased since 2001, reaching 6.9% in 2024, with type 2 diabetes (T2D) accounting for approximately 90% of cases. Diabetes-related healthcare expenditures were estimated at €2 billion in 2022. The European Care4Diabetes Joint Action aimed to transfer and adapt the evidence-based Dutch lifestyle program Reverse Diabetes2 Now to 12 European countries. This study evaluated the transferability and potential effectiveness of the Care4Diabetes lifestyle intervention on metabolic, behavioral, and subjective health outcomes among Belgian adults with T2D in primary care.
Research Design:
This quasi-experimental implementation study was conducted in two primary care centers in Wallonia. Forty-three participants initiated the program and 37 completed the 12-month follow-up. The intervention included a 6-month intensive phase with five thematic group sessions and one individual check-up, followed by an additional check-up and a refresher session at Month 12. Primary outcomes were changes in HbA1c and T2D medication use. Secondary outcomes included anthropometric measures, lipid profile, behavioral outcomes, and subjective health indicators. Linear mixed models were used to assess changes over time, accounting for repeated measures.
Results:
At Month 12, 46% of participants had no change in T2D medication, 43% underwent medication deintensification, and 11% required intensification. After adjustment for T2D medication changes, HbA1c decreased significantly from baseline to Month 6 by 5.4 mmol/mol (0.49%; p = 0.002), but the reduction was attenuated at Month 12 to 2.8 mmol/mol (0.26%; p = 0.06). Sensitivity analyses restricted to participants without T2D medication changes showed significant decreases in HbA1c at Month 6 and Month 12. Body weight decreased significantly (- 3.6 kg at Month 12, p < 0.001). Improvements were also observed in dietary behaviors and perceived general health, and satisfaction among participants and healthcare providers was high.
Conclusions:
The Care4Diabetes program demonstrated good transferability and promising effectiveness in primary care in Wallonia. Larger studies across Belgium are needed to further assess clinical effectiveness and potential economic benefits.