From Plate to Patient: The Role of Nutrition Interventions in Diabetes Control

Abstract

Background: Type 2 diabetes mellitus (T2DM) is highly prevalent in Pakistan and is strongly influenced by diet and lifestyle. While clinical pharmacotherapy is well established, rigorous evidence from randomized trials on culturally adapted nutrition interventions in low-resource Pakistani settings is limited.

Objective: To evaluate whether a structured, culturally adapted nutrition intervention improves glycemic control (primary outcome: HbA1c) compared with standard dietary advice in adults with T2DM attending diabetes clinics in Khyber Pakhtunkhwa.

Methods: This is a two-arm, parallel-group, randomized controlled trial. A total of 120 adults (30–65 years) with T2DM (baseline HbA1c 7.0–10.0%), on stable glucose-lowering medication for ≥3 months, will be randomized 1:1 to the Intervention or Control arm. The Intervention comprises individualized, culturally adapted meal plans developed with local foods, monthly 45-minute counseling sessions by a clinical nutritionist, printed materials, and weekly WhatsApp follow-up messages; the Control arm receives a single standard diet advice session from clinic staff. Follow-up duration is 6 months. Primary outcome is change in HbA1c from baseline to 6 months. Secondary outcomes include fasting plasma glucose, lipid profile (LDL, HDL, TG), body mass index (BMI), dietary adherence (validated score + 24-hour recalls), medication adherence, and patient satisfaction.

Analysis: Primary analysis follows an intention-to-treat principle. Between-group differences in HbA1c will be analyzed with ANCOVA adjusting for baseline values; repeated measures ANOVA or linear mixed models will assess trajectories over time. A p-value < .05 denotes statistical significance.

Expected impact: If effective, the intervention could offer a scalable, culturally congruent model for diabetes care in Pakistan and similar LMIC contexts.

Trial registration / Ethics: To be registered prior to enrolment; ethics approval will be obtained from the relevant institutional review board.